Affordable Care Act Will Improve Medicare Quality Of Care

The Department of Health and Human Services (HHS) has proposed new rules that will help hospitals, doctors, and other health care providers coordinate and provide better care for Medicare patients.

Accountable Care Organizations (ACOs) create incentives for providers of health care to work together when treating individual patients in different situations such as hospitals, doctor's offices,and long-term care facilities.

The Medicare Shared Savings Program will reward ACOs that will lower health care costs while still putting the patients first and providing quality care. Participation in the ACO is voluntary for both the provider and the patient.

HHS is currently holding a series of listening sessions during the public comment period. The Centers for Medicare & Medicaid (CMS) wants to make sure the public understands the proposed rules and how to get involved in the public comment process.

According to HHS Secretary Kathleen Sebelius, "The Affordable Care Act is putting patients and their doctors in control of their health care". She added that "For too long, it has been difficult for health care providers to work together to coordinate and improve the care their patients receive. That has real consequences: patients have gaps in their care, receive dulicative care, or are increased risk of suffering from medical mistakes. Accountable Care Organizations will improve coordination and communication among doctors and hospitals, improve quality care of the care their patients receive, and help lower costs."

The idea is to focus on the needs of the patient and linking payment rewards to actual outcomes, this reform will help improve the overall health of individuals and communities while saving the Medicare program around $960 million over three years.

With thia ACO proposal, teams of doctors, hospitals, and other health care providers will work together to coordinate and improve patient care for those covered with Original Medicare. For the ACOs to share in savings, they would need to meet quality standards in five categories:

1. Patient/caregiver care experiences

2. Patient safety

3. Preventive health

4. At-risk population/frail elderly health

5. Care coordination

If the ACOs are able to save money by getting Medicare beneficiaries the right care at the right time, by improving access to primary care to avoid trips to the emergency room, the ACO can share in those savings with Medicare.

If ACOs do not meet quality care standards, they are not allowed to share in the savings with Medicare and over time can be held accountable. The new program is scheduled to begin on January 1, 2012. Prior to the new rule being finalized, CMS will review all the public comments and may modify the proposal based on the public comments.

According to CMS Administrator Donald M. Berwick, M.D., "An ACO will be rewarded for providing better care and investing in the health and lives of patients. ACOs are not just a new way to pay for care but a new model for the organization and delivery of care."

These proposed rules are just one part of a larger effort by the Obama Adminstration to improve the quality of health care for Americans. The HHS announce the new National Quality Strategy which will provide a tool to better coordinate quality initiatives between private and public partners.

Also, the Affordable Care Act created a new Center for Medicare and Medicaid Innovation that will test innovative service delivery models and care. The CMS is looking at how the Innovation Center will try alternative payment models for ACOs.

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