Assume you are the chief executive officer CEO of a large te

Assume you are the chief executive officer (CEO) of a large technology-intensive hospital in a community of 200,000 people that includes two other smaller community hospitals and a wide range of physicians and other providers working in private practice. Currently, you are paid by Medicare—the federal insurance program for the elderly—a fixed amount for every admission to your hospital, based on the severity of the patient’s needs. Physicians and other providers in your community are paid fee-for-service. The federal government has just made an offer to your community that it form an ACO that could accept a capitated annual payment for each person eligible for Medicare.

How would you go about deciding whether to accept the government’s offer? Take a position for or against and argue for your point.

Would you want to lead the ACO or just be a part of it?

How might you change the way care currently is organized in your community, given the new financial incentives embedded in the capitated rate? How would you coordinate with other hospitals and providers?

Solution

Solution :

a) Capitated annual payments are defined, periodic, per-patient payments (usually monthly) for each individual enrolled in a capitated insurance plan. For example, a provider could be paid per-month, per-patient, despite how many times the patient comes in for treatment or how many services needed. The payment varies, depending on the capitation agreement, but generally they are based on characteristics such as the age of the individual enrolled in the plan. The governments offer can be accepted as it would help bring down rising health costs and also bring in more patients .

b) The position is for accepting the Government\'s offer .

c) It would be better to lead the ACO as there are two other smaller community hospitals and a wide range of physicians and other providers working in private practice in the community . The two smaller community hospitals can also be made part of ACO

d)  Providing patient-centered care might translate into extended hours, open-access scheduling and the opportunity to request refills and appointments online. ACO-related initiatives will require changes in staffing, staff roles and clinician workflow and scheduling. “To effectively manage population health, practices must reengineer their workflow and adopt health IT automation tools that will enable them to reach out to patients who need services, and keep track of their population in the most efficient way by coordinating with other hospitals and providers .