Executive Summary Introduction Health care expenditures are increasing at a rapid rate in the United States each year. One option to decrease expenditures and increase patient outcomes is the implementation of the Accountable Care Organization. The following discourse summarizes the goal of ACOs, the goal of the ACO, implications and barriers to ACO start-up, and nursing implications for both entry-level nurses and advanced practice nurses. Objective The purpose of the communication and objective of the report is to provide background information for the PNP Hawkeye Hospital Board to make a decision as to whether or not becoming an ACO is a viable option for the organization. If so, the discourse provides potential implications and barriers …show more content…
The overall goal of an ACO, which may include physicians, hospitals, and other healthcare professionals, is to provide quality care while meeting defined outcomes and indicators. Overall, the implementation of the ACO should allow for decreased healthcare expenditures. The concept of the ACO is not without barrier to implementation; it affects all healthcare providers and requires extensive interdisciplinary work and increased communication. Nursing practice is influenced by an ACO; staff nurses will be influenced and advanced nurses will be affected. Overall, additional responsibility will be placed on the role of the …show more content…
The goal for ACOs are to provide the correct care for the patient, within an adequate time frame, preventing unnecessary services, and protecting the patient from clinical mistakes (Centers for Medicare and Medicaid Services, 2015a). The program is voluntary for healthcare professionals (HCPs); if agreed to be in the ACO, the clinician must understand the necessary infrastructure of coordination and quality to meet the patient’s care needs within the guidelines. In doing so, HCPs in an ACO should understand the financial benefits and risks associated with losses and gains based upon outcomes and quality (Centers for Medicare and Medicaid Services, 2015b). To meet the needs of an ACO, an interdisciplinary team must work both inpatient and outpatient to meet defined indicators and outcomes. Appendix A provides an example of HCPs providing care, both inpatient and outpatient and the relationship to
Description of Participants Of the 16 suggested stakeholders, 13 individuals participated in the telephone interviews (87% response rate). Across respondents, with the exception of Region 3, all the Idaho regions identified in Exhibit 1 were represented. The respondents represented a variety of professional positions, including Chief Executive Officers (CEOs), Chief Information Officers (CIOs), Executive Directors, other hospital administrators, and physicians, including primary care providers and specialists.
CMO continues to meet weekly and as needed with division leaders to identify issues and factors that need to be addressed in order to ensure the appropriate operational approaches that should impact clinician as well as client satisfaction and therefore better outcomes. 1. Ongoing in-services for our prescriber staff in the use of our Electronic Health Records (EHR) continue to translate into improvement of the required content in order to justify appropriate billing codings to enhance our collection rates. Chief Medical Officer has personally being reviewing a random number of cases per provider and meeting with them individually to provide feedback and improve their performance. This should also impact obtaining the documentation needed for appropriate coding and improved collections.
The ACO would be a patient-centered association where the patient and providers are proper
ACO’s rely heavily on healthcare providers for leadership where consequences rest solely on one individual. Their values are centered around the organizations goals which typically is concerned with its market value. The quality of care received from ACO’s are typically set in urban areas with large populations. This can lead to longer wait time’s and providers becoming less interpersonal with their patients. With increased patient volume and providers being overwhelmed, the quality of care can be dismal.
Clinical integration makes it possible for physicians and hospitals to defuse competition and overcome separation. The Accountable Care Organization (ACO) has recently made efforts to take part in clinical care that is provided to patients by sites of care and other providers. This provides an opportunity to manage services by managing chronic illnesses, centralized scheduling, clinical pathways, electronic health records and programs that are innovative. Clinical integration in provision of care is also important in ensuring delivery of affordable care and high quality in the current environment. The ACO allows coordination of primary care givers in the field of provision of healthcare.
Healthcare organization becoming and maintaining the ability to be a highly reliable organization has developed into a critical focus for not only patient care but also regulatory agencies and managed care organization. In week 4, I chose for my health care organization, the staffing, and scheduling processes make the organization highly reliable through advanced-access scheduling which provides an efficient and patient-friendly method of scheduling to patients ' and the delivery of care. Through EHR we are able to provide patients with more fast, effective and efficient care with more easy access to their health record. EHR provide great benefits for the providers, patients, and health care organization. For providers, they are able to obtained
The paper on triple aim for Accountable Care Organizations (ACOs’) provides great insight into how we can contribute to solving the opioid crisis as curbing the opioid crisis will contribute to lowering cost, improving quality and improve population health overall. Given that by their nature and function seeks to coordinate and improve multiple teams and levels of healthcare providers and professionals insurers and patients which can be very complex. The paper used a very effective High Reliability Organization (aircraft industry) to analyze how; key processes through which organizations achieve reliability; leadership and organizational practices that enable it and the role that professionals can play when charged with enacting it. The
Educational Preparation of Clinical Nurse Leader (CNL) The vision for the Clinical Nurse Leader CNL role began in 2003-2004 in response to the Institute of Medicine’s quality and safety reports. In 1999, the Institute of Medicine released its report, To Err Is Human: Building a Safer Health System, which called on health care systems to reduce medical errors and improve patient safety. In 2002, the Robert Wood Johnson Foundation called for developing new practice models and enhancing collaboration between education and practice, and in 2003, the Institute of Medicine released its set of five core competencies that all clinicians should possess, regardless of their discipline, to meet the needs of patients in the 21st-century health care system. The Clinical Nurse Leader (CNL) is a master’s educated nurse, prepared for practice across the continuum of care within any healthcare setting.
Shared governance is an innovative model used to provide direction for the professional practice of nursing. This model is used to direct nurses to participate in unit-based decision making that allow nurses to demonstrate accountability and ownership for their practices. The goal of the model is to improve quality patient care contain costs, and retain nursing staff. According to Marquis and Houston (2012), “In shared governance, the organization’s governance is shared among board members, nurses, physicians, and management” (p. 270-271). Shared governance is imperative in the healthcare institutions.
Healthcare Reimbursement Healthcare is made up of many factors. Among those factors are provider reimbursement and the different types of financial methods used by the patients to acquire healthcare services. Provider reimbursement is important and necessary in order to maintain the continuation of healthcare. Like every organization, including non-profit organizations, require revenue in order to pay their healthcare providers, expenses accrued, and to obtain the supplies needed to aid in rendering services. With that said, this is why there are many financial methods such as third-party payers, government agencies, private health insurance, and patient payments.
The expansion of Medicaid through the implementation of the Affordable Care Act (ACA) has initiated many states to try innovative ideas to improve their Medicaid programs. Many states, like Minnesota, had started the reform process prior to the passage of the ACA with the purpose of improving the quality of care for Medicaid beneficiaries and to utilize a more cost-effective system to provide Medicaid benefits. One of the innovative ideas that states like Minnesota is implementing is the use of accountable care organizations (ACOs). This paper will explore ACOs by studying the reforms within the Minnesota Medicaid program. Background Medicaid was originally established by the government to provide medical services and payment for individuals
Physicians and Hospitals go hand in hand when it comes to the medical care of patients, and it is this relationship that allows the patients to receive the care they need and deserve. It is also this relationship that we as health care administrators need to understand. In order to fully understand this relationship we need to define the concept of the integrated physician model. We also need to explain the importance of clinical integration in the strategic planning process, and the dynamics of and controversies surrounding accountable care organizations and alternative approaches to the current health system. I will also explain the advantages and disadvantages for hospitals and physician’s models.
The Affordable Care Act has shifted focus on health and wellness of patient populations urging hospitals to do a community needs assessment and come up with a strategy to address these needs. Hospitals most often partner with community and professional organizations to address the health need (Stempniak, 2014). This is an example of how the four spheres are all interrelated. Nurses are at the heart of this movement, providing the necessary skills, experience and expertise to address the needs of the population being served (Shamian,
In the clinical setting, the nurses’ expertise can be used to make clinical assessments and recommendations for routine care at a lower cost than a physician visit. This would increase the number of patients seen and increase the quality of the care provided. The advance practice nurse would be able to hone in on preventative measures and increase patient education. The advance practice nurse can also make recommendations about practice changes needed to facilitate better health outcomes through the use of evidence-based practice. Nursing leaders are aware of how important nursing science is to provide needed evidence to transform practice, even though, finding the time and resources to support any research activity is often challenging (Stone, 2017).
The ABCD: A HCP’s care should not only be centred on patients’ conditions, but should be holistic and include parameters such as patients’ emotional/spiritual