After the American Hospital Association released its Accountable Care Organization (ACO) report on start up costs, many health systems are rethinking how they want to structure their organization. The report, which estimated start up costs for ACOs ranging from $11.6 to $26.1 million, is a far cry from what the Centers for Medicare and Medicaid Services (CMS) expected - $1.8 million. However, with dwindling Medicare and especially Medicaid reimbursement, health systems are looking for accountable care techniques to lower costs and in some instances increase reimbursements.
Accountable care is a far stretching term meaning health systems will be held responsible for the quality of care they provide to their patients. From finding methods to reduce readmissions to being rewarded Medicaid and Medicare incentives, or in some cases penalties, for patients’ hospital experience, accountability equates to value of care.
4 Accountable Care Techniques:
The Patient-Centered Medical Home:
The PCMH is a concept gaining momentum as more research on its effectiveness is demonstrated. A study by Group Health Cooperative found that after one year medical home patient visits to emergency rooms decreased by 29%, the rate of hospitalizations dropped by 11% and the medical home had 6% fewer in-person visits. Similarly, a study published in the Joint Commission Journal on Quality and Patient Safety saw PCMH diabetes patients improve mortality rates and outcomes. While there are up front costs for implementation, the enhanced quality makes financial gains a reality.
Hospital Staff and Culture:
Nurses are a core component in making patients feel at ease and ensuring a clear physician patient communication pathway. A study published in the AORN Journal advocated nurses to have lead roles in quality projects taking place in the operating room. This would result in enhanced outcomes and improved hospital revenue. By ensuring safe care and promoting wellness and prevention, they can improve outcomes and hospital finances. By implementing quality initiatives such as informing patients and patients’ families about what is to happen and future treatment steps to take, patient satisfaction is increased and avoidable readmissions reduced.
Preventing Readmissions:
The amount of preventable admissions is staggering. Caused by a multitude of reasons, from hospital acquired infections to a break down in the communication cycle, whatever the reason may be, hospitals across the country need to be taking measures to address these issues. According to a 2005 MedPAC study, Medicare paid $15 million in readmissions, an estimated $12 million of which could have been avoided.
Value Based Purchasing:
In this health care delivery model, incentives can be reached based on how well the hospital performs on certain quality measures, or how much the hospital’s performance improves compared to its performance during a baseline period. There are 25 measures that determine performance including: patients’ communication between physicians and nurses, hospital staff responsiveness, patients’ pain management and hospital cleanliness. The higher the performance the higher the incentive payment will be.
In my opinion, accountable care revolves around more attention focused on patient outcomes, better coordination of care and collaborative communication between hospital members.
James Ellis, CEO, Health Care Realty Development Company, is a nationally recognized successful real estate investor and developer of medical office properties with a comprehensive knowledge of sophisticated real estate transactions, cost effective designs, and efficient property management.
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