Are you in an ACO?

The question is – do you know if your healthcare provider is a member of an ACO?
And if your healthcare provider is part of an ACO, what does that actually mean to you, the ACO patient?
The Affordable Care Act had many purposes, including finding ways to eliminate waste and save money.
One concept to emerge from the Affordable Care Act is the Accountable Care Organization, or ACO, which is designed to do both. Here is how the Centers for Medicare & Medicaid Services (CMS) defines Accountable Care Organizations (ACOs):
“Accountable Care Organizations are groups of doctors, hospital, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.”

 

ACOs are legal entities, constructed according to strict legal guidelines. The premise is that ACOs will better coordinate the care of their patient population, which will improve the efficiency of delivering care and lead to more effective care.
The way it works is that an ACO manages a defined Medicare population. The fundamental provider in an ACO is the primary care physician, who can improve patient care by promoting disease prevention, providing early diagnosis and limiting unnecessary care. If the ACO is able to deliver quality care at a cost savings, the ACO may share a portion of the money saved.
Medicare says that ACOs will be able to do that because they will offer the right care at the right time.
Medicare also says that ACOs do not in any way limit access to providers or hospitals, that they are not HMOs and that patients in ACOs have complete freedom to choose any provider accepting Medicare.
And there is the fundamental incongruity. The ACO is incentivized to reduce care in order to share cost savings. Providing care costs money. Providing less care saves money.
The best way for Medicare patients to ensure that they have access to the right care at the right time is to understand what an ACO is, to find out if your healthcare provider belongs to an ACO, and to understand that you have the right to choose “any hospital or doctor that accepts Medicare, at any time, even if that hospital or doctor isn’t a part of an ACO. Your doctor may make recommendations, but it’s always your choice.”
Medicare answers questions about ACOs here http://bit.ly/2ilooee


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