A Major Component Of The 2010 Patient Protection And Affordable Care Act

1089 Words Nov 11th, 2015 null Page
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 they lower costs while meeting quality standards (Ginsburg, 2011).

The ACO concept is the newest in a series of attempts to rectify the problems of fee-for-service payment, which has been shown to incentivize the provision of excessive services rather than prevention, effective disease management, and coordinated care. However, a distinct element of the model under the MSSP is that unlike traditional managed care systems, patients may choose to see providers outside of their ACO network. This specification is clearly spelled out in the Centers for Medicare and Medicaid Services’ (CMS) Final Rule Provisions for Accountable Care Organizations under the Medicare Shared Savings Program, and is emphasized as being a “significant difference”…

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