Accountable Care Organization
Accountable Care Organizations (ACO) improves quality and patient care outcomes whilst reducing the total cost of healthcare (Panning, 2014). ACOs consist of three programs that assist in obtaining better value for the health care system and for the patient by involving coordination, transition, and patient involvement. What this means for health care providers such as nurses is providing high quality patient-centered care, and reducing costs at the same time through playing the role of care coordinators, communicators, and quality improvement managers. This brings on more challenges for nurses, and can affect patients as well. This paper will examine how health care providers are affected by Accountable Care Organizations, how it affects the patients, the challenges nurses will face, and the role of health care workers changing due to these challenges.
Accountable Care Organization Impact on Healthcare Providers
Accountable Care Organizations (ACO) are a component of the Patient Protection and Affordable Care Act (ACA) created to improve quality and patient care outcomes whilst reducing the total cost of healthcare (Panning, 2014). The concept is based on the idea that well-coordinated care can help transition patients from acute care to preventative care, provide wellness, and better quality of care while also decreasing duplicate services to reduce medical errors and patient adverse outcomes (Nursing Alliance for Quality Care, n.d.; Panning, 2014; Summers, De Lisle, Ness, Birchfield Kennedy, & Muhlestein, 2015). ACOs are groups of physicians, hospitals, and other health care providers working together to take responsibility for improving patient quality of care (Summers et al., 2015). They are patient-centered, and demonstrate improvement in obtaining better value for the health care system and for the patient by involving coordination, transition, and patient involvement (Panning, 2014). Physicians and providers within ACO coordinate care through the use of Health Information Technology (HIT), effective communication, and care coordination staff to ensure patients get the right care at the right time in the right place (Summers et al., 2015). The data generated from use of health information technology can indicate improved health care delivery and outcomes (Panning, 2014). To achieve savings and earn incentives, Panning (2014) states ACOs have to meet quality standards in patient caregiver experience, care coordination, patient safety, and preventative health and elderly health, or at risk populations. Reimbursement will be issued in a form of a bundled payment from a fee-for-service (Panning, 2014).
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ACOs offer three programs; the first ACO program is the Medicare Shared Savings Program, which is expected to “improve beneficiary outcomes and increase the value of care by promoting accountability for care, requiring care coordination across the continuum and requiring investment in infrastructure and improved care processes” (Panning, 2014, p. 113). The second ACO program is the Advance Payment Model designed for physicians and providers to coordinate high quality care for Medicaid patients (Panning, 2014). The Advanced Payment Model works by giving upfront monthly payments to selected patients to use towards their care (Panning, 2014). The third ACO program is the Pioneer ACO Model designed for health care organizations that already have experience coordinating care for patients, and collaborate with private payers to improve quality and patient health outcomes across ACOs while saving costs (Panning, 2014).
How Nurses are Impacted
The role of nurses in Accountable Care Organizations is similar to that of physicians and other health care providers; to provide high quality patient-centered care, and reduce costs at the same time (NAQC, n.d.). How nurses are impacted and play the part in ACOs are by serving as care coordinators, communicators, and quality improvement managers. As care coordinators, nurses are required to organize care from physicians, pharmacists, specialists, and other sources to ensure delivery of high quality care to patients (NAQC, n.d.). Nurses also play the role of communicators as ACOs rely on them to communicate and translate choices of care plans and treatment plans to patients and families because of their skills in health education and communicating information (NAQC, n.d.). Because nurses are already experts in interacting with patients and families regarding diagnoses, medications, and discharge care instructions, ACOs utilize nurses for these skills (NAQC, n.d.). As quality improvement managers in ACOs, nurses analyze data gathered from the National Database of Nursing Quality Indicators (NDNQI) to measure nurse care processes and outcomes, and use this data to improve delivery of quality of care (NAQC, n.d.).
Challenges and How the Role of Healthcare Worker Changing
Although nurses play many roles in Accountable Care Organizations, if they practice as advanced practiced registered nurses (APRNs) such as nurse practitioners, certified nurse midwives, and certified clinical nurse specialists, the statute limits patients in Medicare ACOs to seek treatment with primary care physicians only, not APRNs (NAQC, n.d.). This policy obstacle also prevents nurse practitioners’ patients from being assigned to ACOs, and prevents patients from being counted as beneficiaries if they choose nurse practitioners as primary care providers (NAQC, n.d.). Another challenge nurses face is the roles nurses are normally assigned might be changed to individuals with less experience and knowledge, which can impede patient care and its purpose of ACOs providing high quality patient care (NAQC, n.d.).
As a result of these challenges, the role of health care workers is changing. Not only do nurses treat patients at bedside, serve the role of educators, advocate for patients, and collaborate with other multidisciplinary team members to provide quality care, but these challenges are pushing nurses to advance their practice and obtain higher education in order to play some of the roles ACOs contain. Advanced education and higher practice may indicate added responsibilities for new roles. Nurses will also have to be knowledgeable about quality assurance, illness prevention, health promotion, and disease management to educate patients, and understand data management from data entry into electronic medical records (EMRs) (Bagwell, Bushy, & Ortiz, 2017). Because of these challenges, nurses may also need to serve on ACO governance boards to provide insight, develop, and implement policies that impact the community they serve (Bagwell et al., 2017).
Accountable Care Organizations and How it Affects Patients
Accountable Care Organizations impact consumers, who are the patients in ACOs, by rewarding hospitals and physicians for keeping patients healthy rather than being rewarded based on procedures and tests performed (Summers et al., 2015). Patients can now use health information technology to access their medical information documented in the ACO’s electronic health records. These patient portals allow patients to check on test results, access educational material, contact their physician, and update patient information (Summers et al., 2015). ACOs also allow family and patients to be a part of the care team. Patient and family engagement can provide better health outcomes, improve patient safety and quality care, and help control health care costs (Summers et al., 2015). ACOs do impact patients, but in a positive way as it aims to focus care around the patient by assisting them in tracking their own health, coordinating care to respective physicians to reduce multiple tests and procedures, and involve them in planning their own care so that they are their own nurses at home.
Accountable Care Organizations (ACO) was created to improve quality and patient care outcomes whilst reducing the total cost of healthcare. ACOs consist of three programs that assist in obtaining better value for the health care system and for the patient by involving coordination, transition, and patient involvement. Though the idea is to help patients in the long run, nurses and health care providers are impacted as well by serving as care coordinators, communicators, and quality improvement managers; they coordinate care from physicians, pharmacists, specialists, and other sources to ensure delivery of high quality care to patients, communicate and translate choices of care plans and treatment plans to patients and families because of their skills in health education and communicating information, and analyze data gathered from the National Database of Nursing Quality Indicators (NDNQI) to measure nurse care processes and outcomes, and use this data to improve delivery of quality of care. The impact on patients is positive as patients can now use health information technology to access their medical information documented in the ACO’s electronic health records to view results, lab work, and update personal information.
- Bagwell, M. T., Bushy, A., & Ortiz, J. (2017). Accountable care organization implementation experiences and rural participation: Considerations for nurses. The Journal of Nursing Administration, 47(1), 30–34. Retrieved from doi:10.1097/NNA.0000000000000433
- Nursing Alliance for Quality Care. (n.d.). The role of nurses in accountable care organizations [PDF file]. Retrieved from http://www.naqc.org/Main/Resources/NursesRole-AccountableCareOrg.pdf
- Panning, R. (2014). Accountable care organizations: An integrated model of patient care objectives. Clinical Laboratory Science, 27(2), 112-8. Retrieved from https://search.proquest.com/docview/1530677910?accountid=34574
- Summers, L., De Lisle, K., Ness, D. L., Birchfield Kennedy, L., & Muhlestein, D. (2015). How accountable care impacts the way consumers receive care [PDF file]. Retrieved from http://www.nationalpartnership.org/our-work/resources/health-care/impact-accountable-care.pdf
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