Healthcare Reform

Abstract

Healthcare reform legislation introduces accountable care organizations (ACO) as means to restructure the healthcare payment system. An ACO consists of providers, specialists, and hospitals that share joint responsibility for the quality and cost of care to a group of patients. The purpose of the ACO is to create a financial incentive to restrict growth while ameliorating healthcare quality. ACOs have the potential to reduce fragmentation of care, address provider shortages, and encourage the practice of preventive healthcare. Lack of collaboration between physicians and hospitals, lack of resources, information technology, and negative financial impact are challenges to the ACO model. Master’s prepared nurses will demonstrate leadership and advocacy roles in ACOs while addressing the primary care provider shortage.

Healthcare Reform: Accountable Care Organizations

An important concept in healthcare reform is reducing the cost of Medicare by changing the way in which healthcare providers and hospitals are paid. The Patient Protection and Affordable Care Act and the Reconciliation Act of 2010 brought about healthcare reform that will allow Medicare to reward healthcare providers across multiple sites of care for promoting patient-centered care while meeting cost reduction goals. This voluntary program allows for the establishment of accountable care organizations (ACOs) by January 2012, in which providers organize to take responsibility for the quality, outcomes, and cost of care delivered to a population of patients (Klein, 2010).

Evidence-Based Findings

According to the 2009 Medicare Payment Advisory Commission (MedPAC), ACOs may be formed in practice types ranging from complex integrated delivery systems, to physician-hospital organizations, to physician-centered organizations, but all are comprised of primary care physicians, nurse practitioners, other clinicians, specialists, and at least one hospital. These entities engage in collaborative...