As of 2015, there are at least 73 million people benefitting from the government’s Medicare program, according the Kaiser Family Foundation. As it turns out, it’s not just helping underprivileged citizens get the quality healthcare they deserve, but it’s also helping hospitals protect their bottom line. Indeed, eligibility services—wherein specialists help patients determine their eligibility for Medicaid benefits—have helped hospitals avoid potential bad debt by helping minimize out-of-pocket costs. Since the Medicare program is subsidizing medical care costs, there is a lower probability that outstanding hospital bills will become debt. However, there is a new initiative being proposed that can further improve healthcare revenue cycle management.
A New Model The more people enroll in Medicaid, the greater the government has to shell out for medical assistance. That’s why the Centers for Medicare & Medicaid Services (CMS) announced recently the new Medicare-Medicaid Accountable Care Organization Model. As the name suggests, this new model will take a page from the current ACO model, wherein healthcare organizations coordinate their services to lower medical costs, while providing quality care to patients. In the current ACO paradigm, patients who are enrolled in both Medicare and Medicaid can be attributed to an ACO, although the latter does not have financial accountability for Medicaid expenditure. Under the joint model, however, the CMS is offering ACOs the opportunity to take on accountability for both programs. As the CMS notes, some of the highest-need and highest-risk patients are those enrolled in both the Medicare and Medicaid programs. Why bother taking on more responsibility? This would mean more incentives, which is the reward for ACOs who manage to lower care costs, while offering quality healthcare to patients. As the CMS states, parties who sign up for the joint program can reap the benefits of the Medicare Shared Savings Program. A Work in Progress Of course, any paradigm shift will come with a learning curve. As per Healthcare Informatics, results of the existing Medicare ACO program have been mixed—the financial savings have so far been modest, though the quality improvements have been praiseworthy. Advisory.com, meanwhile, states that only one-third of the current ACOs received a bonus payout last year because other participants missed out of quality care metrics despite lowering healthcare costs. The site adds that better report and data analysis can help ACOs pinpoint where they can improve their services. Still, the ACO model points to a healthcare system that is more collaborative and equitable for everyone involved. Likewise, with the expansion of Medicaid coverage, the joint ACO model might just be the solution hospitals are looking for, to protect their bottom lines. Sources: The ACO quality challenge: Not just about reporting, advisory.com CMS Announces New Medicare-Medicaid ACO Model, healthcare-informatics.com
