Consider This Before Joining an ACO – Review of Ophthalmology

Date: June 2, 2014

Patients and providers can both benefit under a Shared Savings Program alternative to the standard fee-for-service practice.

This article answers the following questions:

  • What drives the Centers for Medicare & Medicaid Services to consider alternatives to paying providers under the current Medicare system?
  • Are Accountable Care Organizations one such alternative payment system?
  • Are Shared Savings Program concepts aligned with the Affordable Care Act?
  • Will this Shared Savings Program save CMS dollars?
  • Is an ACO just another kind of health maintenance organization?
  • How are Accountable Care Organizations structured?
  • Do different ACO models exist?
  • Will participating providers face reduced reimbursements on their claims if they join an ACO?
  • What motivates a provider to join an ACO if reimbursement rates are the same as their MPFS rates?
  • How will quality of care be measured?
  • What if an ACO doesn’t meet performance and savings benefits?
  • Must providers participate in an ACO?
  • Has CMS released any information about the money saved by ACOs?
  • Are patients required to join an ACO?
  • May ophthalmologists and optometrists join more than one ACO?

Published in: Review of Ophthalmology's Medicare Q & A column

Written by: Vice-President, Donna McCune, CCS-P, COE, CPMA

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