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Will Accountable Care Organizations Pave the Way for Change?

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 ACO’S- And the Debate continues…

Are accountable care organizations the future of the healthcare industry ? Or will they force independent practices to shut their doors ?

According to a recent report 49 percent of primary care physicians and 53 percent of endocrinologists are expected to switch to the ACO model in the coming year.

Financial Security and Better Care.

Physicians who’ve partnered with ACOs are provided incentives for prescribing more generic medication. They are also encouraged to lower hospitalization costs. This accent on the quality of care and containing costs can offer clinical benefits and savings, for healthcare providers.

 The much needed Compass…

One of the major reasons attributed to the popularity of ACOs is that they provide a sense of direction. And help physicians to focus on quality metrics, to receive reimbursement and incentives.

It is Not all Gravy…

There are strong oppositions to practices adopting the ACOs model of working. Some section of the healthcare sector, feel it can pressurize independent practices, to join larger organizations. The clinical benefits it offers are also viewed with a sense of skepticism.

The sustainability of independent hospitals is one major concern. And the fact that it focuses more on hospitals rather than physicians is another key factor that works against acos.

Will it join the IDNs of the 90’s ?

Integrated delivery networks were followed by several healthcare providers in the 90’s. Hospitals followed and pursued two strategies, of vertical and horizontal integration. There were different models such as strategic alliances and acquisitions. There was one common factor that bound all the models together, they just didn’t work.

Whether acos join the ill fated idns of the 90’s, or become the, future of the healthcare industry, remains to be seen.

Are Private Practices being given the Rough End of the Stick?

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Everybody who’s a name to reckon with in the healthcare industry is at the MGMA12 conference. One of the most pertinent topics discussed was the cookie cutter situation private practices are in. The healthcare landscape is changing and as we all know change can be expensive! It is going to take a lot of effort for small independent practices to stay afloat.

                       

 A Tough Call to Take !

According to recent studies physicians gravitate towards working for multispecialty hospitals, than take the risk of, branching out on their own. The possibilities, advantages, losses and responsibilities can be huge. But the future certainly isn’t bleak for the small practice owner.

The ACO HandShake .

There is a lot of controversy, diverse opinion and heated arguments about small practices collaborating with ACO’s. Some industry experts feel that is could sound the death knell for independent practices and can only benefit large scale “for profit insurers”. But the most widely agreed upon view is that ACO’s hold lots of promise and benefits in the long run.

The Trade-Offs .

It is important for independent medical practitioners to understand the medico-legal implications. Whether it is delivery mistakes or data leaks, the risks can almost outweigh the rewards, at least in the short term. Physicians will have to be completely clued into the minutest of details, before collaborating with an, accountable care organization.

As there is an increasing pressure on small practices to consolidate and build partnerships with the bigger players, it is more important than ever that physicians are aware of the financial aspects of a practice.

Leveraging Resources and Containing Costs…

Making the most of what is available is essential for independent practices to remain independent. Outsourcing tasks that can be outsourced such as medical billing can help in scaling down on costs. And free up in-house staff to attend to more pressing demands such as better patient communication.

Medicare Fraud one of the Biggest Exposes in Recent times

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The Biggest Expose in Recent times !

The healthcare industry is in the news once again. But this time, forentirely the wrong reasons. Medicare fraud has always been discussed about in hushed whispers. The lack of concrete evidence and mutual finger pointing ensured that allegations and counter allegations, soon faded into oblivion.

A 430 Million Dollar Scam.

We repeatedly hear of doctors being brought to book for billing errors. But more often than not it turns out to be miscommunication between the patient and doctor or not following revised guidelines. The recent expose that indicts over 90 physicians for submitting fraudulent bills and cheating medicare of four hundred and thirty dollars reveals a much darker story.

Higher Healthcare Costs… 

It is coordinated frauds like this that hike up the average patient’s bill, medico-legal experts allege. But the biggest fallout of this scam could be that physicians who make genuine mistakes with their bill could face more stringent action. Not to speak of the loss of faith and belief, of the public.

Steering Clear of the Muck.

Physicians will have to ensure that every claim sent out is thoroughly scrubbed and “clean”. A scam of this magnitude is certainly going to put everybody else in the scanner. And as skeletons keep tumbling out of the closet, the dust is not going to settle down anytime soon. Medical practices will have to be fully aware of, and pay close attention to the billing process.

The Man in the Mirror…

Like the cult song, nothing much is going to change if the man in the mirror refuses to change. No healthcare reform, billing audit or screaming headline is going to bring about a better and safer healthcare environment, unless physicians take it upon themselves to ensure their medical practice bills the right way ! Or call up their physician billing company to ensure that they’re following all billing regulations.