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Balancing ACO Objective With Physician Reimbursement Maximization

Balancing ACO Objective With Physician Reimbursement Maximization

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Published by Jacob Thomas
As the U.S. healthcare sector looks up the Accountable Care Organization (ACO) Concept of healthcare delivery with great expectation, physician community is quite apprehensive about their ability to garner reimbursements under a new healthcare delivery altogether. While ACO itself is not a novel concept – there have been umpteen examples of institutions operating on ACO lines – the urgency is such that it warrants an immediate action by the physician community, who can effectively bring down the spiraling healthcare expenditure while promoting quality medical care for an ever growing patient base.
As the U.S. healthcare sector looks up the Accountable Care Organization (ACO) Concept of healthcare delivery with great expectation, physician community is quite apprehensive about their ability to garner reimbursements under a new healthcare delivery altogether. While ACO itself is not a novel concept – there have been umpteen examples of institutions operating on ACO lines – the urgency is such that it warrants an immediate action by the physician community, who can effectively bring down the spiraling healthcare expenditure while promoting quality medical care for an ever growing patient base.

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Published by: Jacob Thomas on Feb 06, 2012
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02/06/2012

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Balancing ACO Objective with Physician Reimbursement Maximization
As the U.S. healthcare sector looks up theAccountable Care Organization(ACO) Concept of healthcaredelivery with great expectation, physician community is quite apprehensive about their ability togarner reimbursements under a new healthcare delivery altogether. While ACO itself is not a novelconcept ± there have been umpteen examples of institutions operating on ACO lines ± the urgency issuch that it warrants an immediate action by the physician community, who can effectively bring downthe spiraling healthcare expenditure while promoting quality medical care for an ever growing patientbase.While theFederal HealthcareDepartment seeks to bring the unsustainable growth rate in healthcarerates ± estimated to be 17.3% of the gross domestic product and projected to be 19.3% by 2019 ±there needs to be complementary effort that can rein in spiraling U.S. healthcare costs, expandaccess, promote wellness and improve the consistency of quality outcomes. Although the task needsto be jointly accomplished by the physicians, health insurance carriers, and policy makers, the role of physicians becomes quite pronounced as they hold the key to success or otherwise of the AccountableCare Concept.Notwithstanding their apprehension about their ability to garner a steady flow of reimbursementsunder the ACO Model ± in an ACO, providers will no longer be rewarded for the volume of careprovided to those who are sick; instead they will be paid based on their ability to keep people healthywith minimal procedures ± physicians would do well to integrate their operational model for betterpatient experience. Once they can build goodwill based on better patient experience, the volume willtake care of itself as satisfied patients themselves become brand ambassadors for promotingphysicians¶ services amongst newer markets. But, before all this can happen, physicians, willing to bein an ACO Model, need to:
y
 
Have people
-
centered health homes that deliver primary care and coordinate with otherproviders as patients move across the delivery system.
y
 
T
ry new approaches to primary, specialty and hospital care to reward care coordination,efficiency and productivity.
y
 
Have tightly integrated relationships with specialists, ancillary providers and hospitals so theyare similarly focused and aligned on achieving high
-
value outcomes.
y
 
P
ractice
P
rovider/
P
ayer
P
artnerships and Reimbursement Models that reward improvedoutcomes, rewarding value over volume.
y
 
Have
P
opulation Health Information Infrastructure, including health information exchanges, toenable care coordination across a designated population.
T
hus, with an open-mined outlook to ACOs ± widely viewed as a way to move from the fragmentationand volume orientation of our existing fee
for
service system towards pay-for-value system ±physician community can look to work cooperatively across the care continuum to help patients reachwellness goals and achieve common measures of success.As physician embarks on an integrated system of healthcare delivery, they would be well-off having anadvisory from competentMedical Billing Companiesthat can offer balanced approach for bothoperational as well as revenue optimization.

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