A major component of the 2010 Patient Protection and Affordable Care Act (ACA) is the promotion of new models for payment and care delivery that control costs while improving quality. One of the most prominent of these new models is the Accountable Care Organization (ACO). ACOs, broadly defined, are groups of health care providers and hospitals joined together as either vertically integrated systems or virtually integrated networks that are responsible for the care of a defined population of patients. A primary means through which the ACA promotes the ACO model is the Medicare Shared Savings Program (MSSP), in which ACOs contract with Medicare to provide care to beneficiaries in the Fee-For-Service program, and are financially rewarded if
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Freedom to choose one’s health care provider is highly valued in the US, and generally speaking Medicare beneficiaries have shown little appetite for plans that restrict this choice, even when those plans offer more generous benefits (Sinaiko & Rosenthal, 2010). In addition to issues of public opinion and consumer preference, arguments have been made in favor of protecting patient choice from an ethical standpoint. It has been suggested that control over referral patterns might place unreasonable constraints on patient autonomy (DeCamp et al., 2014), and that when referral practices are driven by forces outside of the physician-patient relationship it may be unclear whether they are unequivocally in the patient’s best interest (DeCamp & Lehmann, …show more content…
However, in light of public opinion regarding choice restriction and the apparent determination of the CMS to preserve freedom of patient choice, simply prohibiting patients from seeking care outside of their ACO is clearly not an option. Further, such a blanket restriction may not be desirable if we assume that there will likely be some patients for whom this restriction will result in worse quality of care. Therefore, strategies seeking to incentivize patients to stay within their ACO seem to be the best option moving
Freedom to choose one’s health care provider is highly valued in the US, and generally speaking Medicare beneficiaries have shown little appetite for plans that restrict this choice, even when those plans offer more generous benefits (Sinaiko & Rosenthal, 2010). In addition to issues of public opinion and consumer preference, arguments have been made in favor of protecting patient choice from an ethical standpoint. It has been suggested that control over referral patterns might place unreasonable constraints on patient autonomy (DeCamp et al., 2014), and that when referral practices are driven by forces outside of the physician-patient relationship it may be unclear whether they are unequivocally in the patient’s best interest (DeCamp & Lehmann, …show more content…
However, in light of public opinion regarding choice restriction and the apparent determination of the CMS to preserve freedom of patient choice, simply prohibiting patients from seeking care outside of their ACO is clearly not an option. Further, such a blanket restriction may not be desirable if we assume that there will likely be some patients for whom this restriction will result in worse quality of care. Therefore, strategies seeking to incentivize patients to stay within their ACO seem to be the best option moving