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Accountable care organizations
An accountable care organization (ACO) is a group of doctors, hospitals and health care providers who work together to provide higher-quality coordinated care to their patients, while helping to slow health care cost growth. It is characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients.
The ACO may use a range of payment models capitation, fee-for-service or bundled payments, etc.). The ACO is accountable to the patients and the third-party payer for the quality, appropriateness and efficiency of the health care provided. According to the Centers for Medicare and Medicaid Services (CMS), an ACO is “an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it.”
The success of the ACO model in fostering clinical excellence while simultaneously controlling costs depends on its ability to “incentivize hospitals, physicians, post-acute care facilities, and other providers involved to form linkages and facilitate coordination of care delivery, according to A National Strategy to put Accountable Care into Practice. Health Affairs by Dr. Mark McClellan, former administrator of the Centers for Medicare & Medicaid Services (CMS) and former commissioner of the U.S. Food and Drug Administration (FDA). By increasing care coordination, ACOs can help reduce unnecessary medical care and improve health outcomes, leading to a decrease in utilization of acute care services.
Healthcare quality delivered by an ACO is defined by CMS via five domains. They are “patient/caregiver experience, care coordination, patient safety, preventative health, and at-risk population/frail elderly health.”
An ACO’s patient population will primarily consist of Medicare beneficiaries. In larger and more integrated ACOs, the patient population may also include those who are homeless and uninsured. Patients may play a role in the healthcare they receive from their ACOs by participating in their ACO’s decision-making processes.
Medicare Part B Lab Test Prices Versus Budgeted Payment
By R. Lewis Dark | From the Volume XXIII No. 15 – November 7, 2016 Issue
THERE IS AN IMPORTANT QUESTION THAT lab industry magazines and news sources have failed to address: How many years are left before Medicare officials drop fee-for-service payment for clinical lab testing? On January 26, 2015, the Department of Health and Human Services (HHS) issued a press rele…
Can Clinical Laboratories Adjust To ‘New’ Healthcare System?
By Robert Michel | From the Volume XXIII No. 14 – October 17, 2016 Issue
CEO SUMMARY: Month by month, there is increased clarity in the path the American healthcare system will follow as hospitals, health systems, and physicians integrate clinical care, manage populations, and practice personalized and precision medicine. While these changes play out, clinical…
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By Joseph Burns | From the Volume XXIII No. 12 – September 6, 2016 Issue
CEO SUMMARY: There is always a story behind the story, and THE DARK REPORT went to the lead researcher of the reference pricing study published in JAMA Internal Medicine to get it. In this interview, James C. Robinson, PhD, of the University of C…
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By Joseph Burns | From the Volume XXIII No. 8 – June 13, 2016 Issue
CEO SUMMARY: For decades, hospitals were reluctant to allow any outside lab company to run their inpatient lab operations because they preferred to maintain control over quality results and turnaround times. That attitude may be changing as health systems face increasing margin compressio…
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By Robert Michel | From the Volume XXIII No. 6 – May 2, 2016 Issue
CEO SUMMARY: What happens when 100 lab experts interact with an audience of more than 850 lab administrators, pathologists, and IVD executives from across the United States and seven other nations? A consensus of sorts emerges and during this 2016 edition of the Executive War College on L…
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By Joseph Burns | From the Volume XXIII No. 4 – March 21, 2016 Issue
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By R. Lewis Dark | From the Volume XXII, Number 18 – December 28, 2015 Issue
AT THE END OF EACH YEAR, IT IS GENERALLY EASY TO PICK OUT the stories of greatest significance for the lab industry during the previous 12 months. But what is often overlooked are the non-stories. These are the events that did not happen in the year, despite earlier occurrences and the momentum pushi…
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By Robert Michel | From the Volume XXII, Number 17 – December 7, 2015 Issue
CEO SUMMARY: Over the next 24 months, it will be essential for every clinical laboratory and anatomic pathology group to develop clinical and financial strategies that meet the changing needs of health insurers, hospitals and health systems, physicians, and patients. THE DARK REPORT provi…
More AP Consolidation: Aurora Buys Two Groups
By Joseph Burns | From the Volume XXII No. 12 – August 24, 2015 Issue
CEO SUMMARY: Seeing the changes overtaking pathology practices, Brazos Valley Pathology decided to sell two of its group practices to Aurora Diagnostics. Last month’s transaction was not designed to fix financial problems nor was it because of retiring pathologists. Rather, it …
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Volume XXXII, No. 6 – April 21, 2025
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