Role of Governing Boards in Clinics With ACO Status

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Governing boards play a significant role in clinics with the ACO status because their decisions influence the effectiveness of the novel billing structure. Moreover, the executive representatives are responsible for supporting the communication with the state administration, and, as the ACO program is perceived as a demonstration project in New Jersey, provide the health care governors with constructive feedback (Ouayogodé et al., 2017). Governing boards might not have sufficient power to eliminate the unintended consequences of ACO status implementation, yet they commonly include the physicians who can observe the processes and recommend important updates.

Unintended Consequences of Health Care Reform: Accountable Care Organizations

Accountable care organizations (ACOs) are clinics and hospitals where physicians have the value-based billing structure – the Medicare program’s innovation developed to impact the economics of the United State’s health care system. The ACO status can be obtained by public and private facilities and applies to citizens of all socioeconomic groups. Bodenheimer and Grumbach (2020) claim that “ACO payment models try to make fee-for-service payments to physicians and per diem or episode payments to hospitals function more like a globally budgeted payment model” (p. 44). The status is not obligatory for the states to require from the clinics, and there are more than a thousand health care organizations where the program is enabled. This paper aims to discuss the positive impact and unintended consequences of ACO implementation for clinics and its influence on nursing.

The ACO model aims to enable the clinics to increase the health care services quality without raising their costs. The Affordable Care Act passed in 2010 initiated similar reforms to be developed and established to optimize the facilities’ expenses and regulate insurance (HealthCare.gov, n.d.). The ACO program has positive impacts, such as providing physicians with the inability to focus more on clients’ outcomes and serve the local beneficiaries’ needs with less cost. Indeed, when the bonuses and fees do not depend on the number of appointments, medical professionals apply patient-centered treatment approaches (Gu et al., 2021). The positive result is that the government currently supports investments for the ACOs, and the clinics can address local health care issues such as certain chronic diseases prevalence in a region.

Unintended consequences of the ACO program are the necessity for physicians to refer to the specialists of organizations with the same type, the number of which is limited, and the demand for updating multiple protocols and working algorithms for the workforce. There are only around one thousand ACOs nationwide, creating an inevitable shortage of professionals for reference (Kaufman et al., 2019). Furthermore, the protocols of actions for nursing practitioners and physicians require revision and optimization to reduce the costs, and clinics might face difficulties in implementation, resulting in worsening patient outcomes.

My organization is the East Orange General Hospital Clinic which does not participate in the ACO program; however, there are ACO-certified clinics in New Jersey. One of the program’s requirements in my state is to have a minimum of 5,000 Medicaid beneficiaries, and East Orange General Hospital does not meet this parameter (State of New Jersey Department of Human Services, n. d.). The ACO implementation is established as the demonstration project as per New Jersey’s policies, and, in the case of benefits’ prevalence, the conditions to participate will be eased to help more organizations join.

Nursing practitioners working at ACOs can also benefit from the program as their clinic would encourage them to provide the best quality of care to address the value patients give to the services. Indeed, the financial accountability for costs enables NPs to improve their skills and obtain the efficiency strategies for their organizations to meet the expectations (Gu et al., 2021). Furthermore, the nursing profession would be more balanced in terms of time and effort it requires if all the operations were value-based. Consequently, the more clinics become ACOs, the better working conditions for practitioners would develop.

Health care system reforms are necessary for making the services affordable for the broader population, and an ACO is an initiative that can help clinics achieve that goal. The positive impacts for an organization are the ability to improve their patient-centered practices and address the specific needs of the beneficiaries. The unintended consequences that complicate the work of ACOs are the requirement to refer only to other similar clinics’ specialists and the demand for changing the working protocols and algorithms. Initiatives and reforms related to the health care costs regulation are beneficial for the nursing profession as the practitioners would accelerate their patient care skills.

References

Ouayogodé, M. H., Colla, C. H., & Lewis, V. A. (2017). Determinants of success in Shared Savings Programs: An analysis of ACO and market characteristics. Healthcare, 5(1-2), 53-61. Web.

Bodenheimer, T., & Grumbach, K. (2020). Understanding health policy: A clinical approach (8^th ed.). McGraw-Hill.

Gu, J., Huckfeldt, P., & Sood, N. (2021). The effects of Accountable Care Organizations forming preferred skilled nursing facility networks on market share, patient composition, and outcomes.Medical Care, 59(4), 354-361. Web.

HealthCare.gov. (n.d.). Understanding the Affordable Care Act: About the law. Web.

Kaufman, B. G., Spivack, B. S., Stearns, S. C., Song, P. H., & O’Brien, E. C. (2019). Impact of accountable care organizations on utilization, care, and outcomes: A systematic review.Medical Care Research and Review, 76(3), 255-290. Web.

State of New Jersey Department of Human Services. (n. d.). Accountable Care Organization. Web.

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Role of Governing Boards in Clinics With ACO Status

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