The healthcare landscape is changing significantly as the Patient Protection and Affordable Care Act takes hold. Annual requirements and payment programs are shifting constantly. Accountable Care Organizations (ACOs) are one particular area where medical organizations are making adjustments.
Spine surgeons have several options when it comes to ACOs. They can choose to participate with an ACO, partner with accountable care providers without direct participation, or choose not to work within this framework whatsoever.
“Aligning with a medical group or a hospital ACO including a medical group would be extremely beneficial as the new structures are forming,” Dr. A. Nick Shamie, associate professor of spine surgery at UCLA and president of the American College of Spine Surgery, told Becker’s Spine Review. “This is especially true to busy, competitive markets, such as in big cities where hospitals are purchasing physician practices.”
The source went on to explain the benefits of working within an ACO such as increased care coordination, improved physician practice workflow efficiencies, and easier access to critical medical information. There are a variety of payment programs to choose from when aligning with ACO providers.
The Medicare program offers the Shared Savings Program and the Advanced Payment ACO Model while private insurers offer one-sided shared savings, two-sided shared savings, bundle payments, and global payments.
The Affordable Care Act is making an impact by influencing physicians toward these new payment methods like shared savings, bundled payments, and ACOs, which will likely diversify revenue cycles in the coming years, according to Becker’s Spine. Health insurance exchange plans may also view in-network providers more favorably, especially those with higher volumes.
Additionally, spine surgeons should be aware of new penalties taking place in two years for not reaching electronic medical record requirements or participation in Physician Quality Reporting Systems. Clearly, the Affordable Care Act and other healthcare legislation is affecting the medical sector and physicians should pay attention to all new changes to their practice.