Question

See Required Readings in Lesson 12

Questions

Part A

Based on the above resources, address the following questions:

What are ACOs? What is the motivation for different types of ACOs?

What are the risks and rewards of ACOs from a reimbursement perspective? Describe them.

What are the implications of managing health information if your organization becomes an ACO?

NOTE The suggested number of words for all questions combined is 400.

Part B

TIP Refer to “Commentary 2: Demonstrating ACO Quality Measures” and the Tutorial for Commentary 2.

The attached Excel spreadsheet has sample patient HbA1c test result data for diabetic patients. Based on Commentary 2 and the tutorial (follow the process outlined), answer the following questions for the Excel data file:

You are in charge of preparing ACO reports for your organization and you need to find out what percentage of patients in 2016 had their HbA1C levels under 8. What percentage of patients have their HbA1c levels under 8?

You are in charge of preparing ACO reports for your organization and you need to find out what percentage of patients in 2016 had their HbA1C levels over 9. What percentage of patients have their HbA1c levels over 9?

Answer 1

What is an ACO?

ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients. The objective of composed consideration is to guarantee that patients get the correct consideration at the ideal time, while staying away from pointless duplication of administrations and avoiding medicinal blunders.

At the point when an ACO succeeds both in conveying amazing consideration and spending human services dollars all the more admirably, the ACO will partake in the investment funds it accomplishes for the Medicare program.

What is the motivation for different types of ACOs?

• ACO professionals (such as physicians and hospitals) in group practice arrangements
• Networks of individual practices of ACO professionals
• Partnerships or joint venture arrangements between hospitals and ACO professionals
• Hospitals employing ACO professionals
• Other Medicare providers and suppliers as determined by the Secretary

What are the risks and rewards of ACOs from a reimbursement perspective?

Incorporated Delivery Systems – regular responsibility for, doctor rehearses and maybe insurance agencies with very much adjusted money related motivators, electronic restorative records, group based consideration and assets to help savvy care

Multispecialty Group Practice – have solid affiliations with healing facilities. They more often than not don't possess the wellbeing plan, however have contracts with various wellbeing designs

Doctor Hospital Organizations – subset of the healing center's medicinal staff – some capacity like multispecialty assemble rehearses

Free Practice Associations – singular doctor rehearses that meet up to contract with wellbeing designs

Virtual Physician Organizations – for the most part doctors in provincial territories

What are the implications of managing health information if your organization becomes an ACO?

An assortment of Accountable Care Organization (ACO) models have been built up by The Centers for Medicare and Medicaid Services (CMS) and by business payers. In a wide range of CMS ACO and commerical ACO models, regardless of whether it's a CMS ACO or business ACO, suppliers are qualified for rewards dependent on investment funds and results.

Most visible and often discussed, are the several different ACO models offered by CMS, including:

• Medicare Shared Savings Program. The Medicare Shared Savings Program (MSSP) encourages coordination among providers to improve the quality of care for Medicare Fee-For-Service (FFS) beneficiaries and reduce unnecessary costs. Eligible providers, hospitals and suppliers may participate.
• Advance Payment ACO Model. The Advance Payment ACO Model is intended for doctor based and rustic suppliers who have met up deliberately to convey very much organized, superb consideration to the Medicare patients they serve. Through the Advance Payment ACO Model, chose guardians get forthright and regularly scheduled installments, which they can use to put resources into their consideration coordination framework.
• Pioneer ACO Model. The Pioneer ACO Model is intended for social insurance associations and suppliers effectively experienced in planning care for patients crosswise over consideration settings. It empowers these supplier gatherings to move all the more quickly from a mutual funds installment model to a populace constructed installment display in light of a track reliable with, however separate from, the Medicare Shared Services Program.

Demonstrating ACO Quality Measures” and the Tutorial for Commentary 2.

The final rule outlines 33 quality reporting measures, which were whittled down from the 65 included in the previous version. “They focus on clinical processes and patient experience-of-care measures,” says Shefali Mookencherry, MPH, MSMIS, RHIA, principal consultant of strategic and advisory services for Hayes Management Consulting.  

The standard's 33 measures are classified into four spaces: persistent/guardian encounter, care coordination/tolerant wellbeing, preventive wellbeing, and in danger populace care. Satisfactory revealing of the almost three dozen estimates will be the concentration amid the principal year of the program. "Essentially what happens is, for the primary year, ACOs simply need to give an account of these quality measures," Mookencherry says, including that in years two and three, ACOs will start progressing from an announcing just to a compensation for-execution structure. By year three, everything except one measure will progress toward becoming pay for execution.

"For the execution estimation, it's everything on the quality side," says Ken Perez, chief of social insurance strategy and senior VP of advertising at MedeAnalytics. Cost information, he clarifies, are as of now transmitted to the CMS through cases movement and other existing information submittal forms, so "there's no announcing required on the cost side."

In a MedeAnalytics white paper, Perez’s team says the rule’s approach is structured “to encourage participation and reduce the reporting burden,” and the criteria show “a clear preference for ambulatory-related measures.” Patient experience-of-care surveys, readmission figures, EHR use, and screening and immunization data are among the measures encompassed in the final rule’s first three domains,while the fourth, which covers in danger populaces, incorporates measurements on diabetes, hypertension, ischemic vascular infection, heart disappointment, and coronary conduit sickness. A few of the in danger populace measures-a large portion of the diabetes measurements alongside the two estimates identified with coronary vein malady are of the win or bust assortment.

You are in charge of preparing ACO reports for your organization and you need to find out what percentage of patients in 2016 had their HbA1C levels under 8. What percentage of patients have their HbA1c levels under 8?

An HbA1c of 48mmol/mol (6.5%) is recommended as the cut off point for diagnosing diabetes. A value of less than 48mmol/mol (6.5%) does not exclude diabetes diagnosed using glucose tests.

Finger-prick HbA1c ought not be utilized except if the strategy and the medicinal services staff and office utilizing it can exhibit inside the national quality affirmation conspire that they coordinate the quality confirmation results found in labs. Finger prick tests must be affirmed by research facility venous HbA1c in all patients.

In patients without manifestations of diabetes the lab venous HbA1c ought to be rehashed. On the off chance that the second example is <48mmol/mol (6.5%) the individual ought to be treated as at high danger of diabetes and the test ought to be rehashed in a half year or sooner if side effects create.

Situations where HbA1c is not appropriate for diagnosis of diabetes:

• ALL children and young people
• patients of any age suspected of having Type 1 diabetes
• patients with symptoms of diabetes for less than 2 months
• patients at high risk who are acutely ill (e.g. those requiring hospital admission)
• patients taking medicine that may cause fast glucose rise e.g. steroids, antipsychotics
• patients with intense pancreatic harm, including pancreatic medical procedure in pregnancy
• nearness of hereditary, haematologic and ailment related elements that impact HbA1c and its estimation (see add 1 of the WHO report for a rundown of components which impact HbA1c and its estimation)

You are in charge of preparing ACO reports for your organization and you need to find out what percentage of patients in 2016 had their HbA1C levels over 9. What percentage of patients have their HbA1c levels over 9?

RGV’s T2DM care program encompasses a wide range of strategies. Staff follow up patient visits with phone calls to remind them about blood glucose monitoring or to make medication adjustments, and uncontrolled patients are linked to nutritionists and certified diabetes educators.  Staff are additionally cautioned about consideration holes through RGV's electronic wellbeing records stage. RGV ACO utilizes purpose of-care frameworks for estimating HbA1c and lipids since they enable clinicians to make quick move on the test outcomes. Getting HbA1c and lipid results amid the visit implies that they take advantage of each visit with no compelling reason to invest extra energy later to pull diagrams for survey and catch up with patients after lab results are returned in the next days. Less time is spent pursuing outcomes and patients with telephone calls and letters. Notwithstanding expanded office productivity, the advantages of POC testing for HbA1c and lipids incorporate better conveyance of consideration, instruction, and preparing; avoidance of extra visits for lab tests and development; and extra patient consistence because of enhanced comprehension.

To date, more than 6,000 patients have been enrolled in this innovative care plan. Results have shown significant improvements in all quality measures, including HbA1c levels, blood pressure and tobacco non‐use, among others. From 2012 to 2014, the number of patients with comprehensive T2DM control increased from 12 to 49 percent,  also, the quantity of patients with HbA1c > 9 percent diminished from 17.81 to 12.83 percent. For the composite score of T2DM measurements, RGV accomplished the main 1 percent of all ACOs in the country. RGV ACO additionally diminished the per capita costs for its Medicare recipients by 14 percent.

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