Health Care Financing

Name

Institution

Health Care Financing

In order to decide whether to accept the offer by the federal government to form an Accountable Care Organization (ACO), I will put a number of factors into consideration. The first step will be to review the contracts that need to be signed before participating, with the help of an experienced legal counsel. This is because the contract could contain provisions that could broadly affect my practice of medicine in the context of ACO. For example, the contract may contain restrictive covenants that may preclude the physicians from joining any other health provider networks after deciding to join ACO. Before accepting the offer, I would also ensure that I review the policies and procedures for participating in the ACO to ensure that they abide by quality measures and clinical protocols and the ability to retain payment records and clinical documentation for a period of ten years.

I would then formulate my compliance plan before participating in the offer and then compare it with the compliance plan for the offer. I would then accept the offer if my compliance plan is similar to that of the offered ACO. The next factor to put into consideration would be to check if there is an equal representation on clinical committees and governance between specialty physicians and primary care. I would also determine whether the hospital’s interests and those of the community are adequately represented in the ACO board in terms of physical representation and voting authority. I would then consider questions such how long the ACO has been into existence, the number of available primary care physicians and specialty physicians, and the size of the provider network, and mostly importantly, the terms and conditions of joining the ACO.

I would argue against accepting the offer because, given the culture of my practice and the culture of the community where the hospital is located, it may not fit so well with the mission, vision and goals of the ACO. The hospital’s financial status is also not viable and is not able to give it enough authority to effectively negotiate with health insurers and other hospitals. In addition to that, my present practice is not able to utilize other payment methodologies beyond the fee-for-service. However, if I were to accept the offer and participate in that ACO, I would choose to lead it rather than being just part of it because as a CEO of a large techno-intensive hospital, deciding to sit back and watch would mean that our role in the participation would never be felt. I would choose a leading role since this would give me the opportunity to change the way care is currently organized in the community by the use of new embedded financial incentives. I would ensure that the ACO has robust and strong primary care infrastructure and information technology systems or electronic medical records to help capture quality metrics and performance data of my hospital.

The tools for health information technology will be very vital in sharing the informed best practices and evidence based data with all the physicians. In order to achieve the ACO design objective for savings, I would consider adopting new approaches other than the system of the traditional fee-for-service. In order to improve the performance of the hospital in my community, I would also consider such practices as bundled payments, quality performance payments, shared savings, risk-based compensation, case-management fees, and outcome-based reimbursement. These schemes will most likely stimulate a provider network that focuses on cost and quality performance goals and also ensure alignment to hospital and physician incentives.