Medicare officials say beneficiaries can receive better health care if doctors and hospitals work together to achieve high-quality, coordinated care. The Accountable Care Organization (ACO) model realigns the incentives for health care providers by paying them for quality of care, rather than for the quantity of services they provide. The goal is to make sure that patients, especially the chronically ill, get the right care at the right time while lowering the cost of providing such care. The coordination of care also seeks to avoid unnecessary duplication of services for patients and the associated costs, and to prevent medical errors.
ACOs receive financial bonuses when they meet quality and cost benchmarks set by the Centers for Medicare & Medicaid Services. ACOs usually include doctors, hospitals and other health care providers, such as health departments, safety net clinics and home care providers. There are various forms of ACOs for which financial incentives and quality benchmarks are set.
There are 33 ACO quality measures that evaluate how well ACOs are doing in areas such as providing preventive care and screenings (such as mammograms and influenza immunizations) as well as the quality of their patients’ experience. Medicare beneficiaries provide feedback by completing surveys on how well providers communicate; the timeliness of care, appointments and information; patients’ rating of providers; and access to specialists.
Medicare patients who see providers in a Medicare ACO maintain all their Medicare rights. Beneficiaries have the right to choose any doctor or provider that accepts Medicare. This allows patients to choose whether to continue seeing a provider who has chosen to participate in an ACO. Health care providers in an ACO are required to alert their patients of their participation.
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