This paper reviews the proposed rule by the Centers for Medicare & Medicaid Services (“Medicare program; Medicare shared savings program: Accountable care
organizations,” 2011) on the formation of Accountable Care Organizations (ACOs). The establishment of ACOs has been included in the revised Patient Protection Affordable Care Act (PPACA) under SEC 1899 Medicare Shared Savings Program. Following this, the CMS has published its proposed rules on May 31, 2011. The publication details the requirements for establishing ACOs, agreement procedures, regulations, and so on. This paper reviews the rule proposed by the CMS and analyzes the reliability and applicability of ACOs in the present health care system.
Background of the Study
Physical health is a precious and priceless possession that every person must value. Exercising regularly, eating a healthy diet, drinking safe water, and staying away from vices are some basic ways people can do to preserve their health. There are many other ways to stay healthy; however, such ways can be very costly such as relieving oneself of stress by going regularly to a spa and massage center, enjoying recreational activities, and keeping an organic garden. Nowadays, it is better to take the necessary precautions to stay healthy and stay away from costly hospitalization and medication. In order to avoid costly and unplanned hospital costs in the future, many people also resort to medical insurances through managed care systems provided usually by Health Maintenance Organizations (HMOs). With HMOs, patients are assured to avail of health services according to the plan they subscribe to. HMOs offer out-patient services, laboratory examinations, medications, physical examinations and hospitalization benefits based on the pre-arranged membership plan. Thus, members can easily access health care service even without money at hand. When hospitalized, patients enjoy the benefits covered by their plan including free checkup with a specialist contracted by the HMO, free or largely discounted hospitalization, free laboratory examinations, home medications, and so on. However, patients under the HMOs have limited benefits according to the coverage of the plan they avail of. Likewise, patients cannot choose the health care providers that would attend to their needs; instead, they will have to access services from those providers (doctors and hospitals) that are connected with their HMO or insurance agency. The benefits that HMOs provide are valuable. People under the HMO can expect to be attended to immediately upon presenting their membership cards to hospitals or clinics covered by their insurance agency. Moreover, HMOs have a wide coverage, thus looking for a hospital or health care provider is not difficult. The existence of HMOs since the 90s has established their credibility and success in providing quality service. The satisfaction surveys conducted (“