Essentially, an ACO is the latest model of care delivery intended to lead to cost savings for the Medicare program, with greater efficiencies and a patient care focus. DHHS claims that “ACOs create incentives for health care providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program will reward ACOs that lower health care costs while meeting performance standards on quality of care and putting patients first." The program will be administered by CMS.
The law requires each ACO to take responsibility for at least 5,000 beneficiaries for a period of three years, and meet certain proposed quality measures. There is also a proposed scoring methodology, including proposals to prevent providers in ACOs from being penalized for treating patients with more complex conditions. Medicare beneficiaries whose doctors participate in an ACO will have a full choice of providers, can still choose to see doctors outside of the ACO, and will have access to information about how well their doctors, hospitals, or other caregivers are meeting quality standards.
And members of the ACOs will need to their HIPAA/HITECH privacy security issues, which are also addressed in the proposed rules. Yet simultaneously, CMS is proposing to allow ACOs to receive data on ACO members/patients who seek services from providers outside of the ACO itself to promote “coordinated care and a better understanding of the population served by the ACO” unless they opt out of such sharing. Privacy specialists may not be pleased.
So stay tuned. We are only at the surface of understanding the privacy and security issues surrounding this new incentive program.
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