The Short and Sweet Physician’s Guide to Accountable Care Organizations

Why do we Need an Accountable Care Organization?

 

Accountable Care Organization

Accountable Care Organization

In practical analysis, the population of the United States demographics is vastly changing. Between the years of 1946 and 1967, the post war baby boom created 76 million American babies. Nearly 11 million of those Americans have died prior to 2012. This leaves 65.2 million aging baby boomers.

When you add to this the number of immigrants in this age group that entered the US after the 1965 Immigration Act, (11 million immigrants), the total of 50-69 year old Americans is brought back up to 76.4 million in 2015 because immigration rate exceeded the amount of baby boomer’s death rate.

Statistics show that by 2029, the baby boom aged population will still be at 61.3 million. Law-makers, seeing these statistical projections saw a desperate need to improve Medicare by lowering operating expenses and improve patient care.

 

Strategize a Model

Strategize a Model

They needed a way to strategize a model of how the professional medical industry, with all its power, would be effectively motivated to improve health care, showing measurable accountability and results in their patients’ health, and do this without manipulative increases in fee for services that would exceed the Medicare budget expectations.

Patient, prior to the implementation of ACO standards, had the option to find appropriate medical care wherever they preferred. They will continue to have this right of flexibility of medical care but this model of the ACO is being motivated to improve their patient services to the point where their care reaches a patient approval rating that keeps patients willing to voluntarily remain within the ACP group of medical care services of primary physicians, specialists, hospitals and other health professionals.

 

Reduce Costs

Reduce Costs

How will ACO’s Reduce Costs and still make Profits?

ACO’s are responsible for Medicare insured patients. When forming their ACO cooperative groups that include the entire array of medical needs for aging Americans, their complete care programs will avoid the “middle man” scenario that has been duplicating efforts, tests and diagnostic procedures, and other medical services that create a waste in added expenses unnecessarily.

If the ACO’s each take a minimum of 5,000 Medicare patients per year, and the standard of health is improved while meeting or beating CMS cost reduction goals, plus meet the accountability standards of quality of care by the Medicare and Medicaid Services, (CMS), each AC) group will be awarded a bonus of 50 percent of their savings below Medicare projected budget for that year. The other 50 percent will be returned into the Medicare fund.

Should some of the ACO models not succeed in specific benchmarks of patient care quality, improved care and cost savings audits, they will still get their expected Medicare insurance reimbursement payments, but there will be no bonuses. In some cases, there will also be penalty payments.

 

Improve service

Improve service

One key to this enrichment of service is focusing on prevention and careful management of chronic care diseases. Thus far in the first year of the Medicare ACO program, participating provider groups saved a total of $380 million, while effectively keeping their patients healthy and out of the hospital.

CMA reports that of the 114 shared savings ACO groups, nearly half had lower spending than what Medicare projected for that year. Only 29 percent of that group had saved enough to earn the savings bonus of 50 percent.

From this, ACO physicians groups are learning that the success of this effort requires that every medical service professional they invite to their group must be motivated to achieve the goals. Because patients maintain their right to seek medical attention outside of their medical care group if they are not happy with their care or services, ACO’s will see increase in patient care cost from outside medical sources.

ACO groups will never have the control over their patients to keep them within their billing system for treatment like the HMO’s did up to the 1990’s. Nor will patients ever be penalized for exercising their right to preferred medical treatment. This means that the only alternative is for ACO’s to provide optimum care and services to keep their patients healthy, confident of their care, and seeing positive results from their treatment plans.

 

Happy Patients

Happy Patients

What Happens to Fee for Service Billing?

Since this program takes the power out of the hands of hospitals and medical care professionals and essentially puts it back into the hands of patients seeking appropriate care, is this the end of Fee for Service billing?

No, hospitals and physician will still be paid more for the more services they offer. The focus is taken off the motivation of performing more procedures to generate more fees. The new focus is on bonuses and penalty fees. As the ACO’s become more proficient at influencing decision makers, (their group clinicians), to offer only beneficial services and make only reasonable referrals to specialists, etc., they will find a balance in not cutting too many services, and generating enough bonuses for a good profit margin.

 

ACO Impact

ACO Impact

How Does the ACO incentive Impact Ophthalmology Practices?

The Ophthalmology practice has not been central to ACO groups until recently because Medicare has always allowed patients to maintain their current Ophthalmology care, even when they receive primary care from an ACO. In fact, physicians may now be inclined to offer financial incentives that encourage patients to try a new eye doctor who is compliant with ACO’s standards.

Ophthalmologists need to insert themselves into the discussions with their local area ACO groups. Many primary care practices are reportedly training their doctors to refer new medicare patients to specialists with a positive record for cost control, have low instances of complications, get good outcomes and provide quality care.

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Simple Ways to Max Out Your Medical Deductions This Tax Season

Tips to Maximize Medical Deductions This Tax Season

Medical Deductions

Medical Deductions

If you have had medical expenses that you paid out of pocket this year, you can likely deduct these from your taxes. In fact, there likely are medical deductions that you have not even considered. The laws regarding this, however, are complex and must be followed to the letter. It’s important to inform yourself about medical deductions so you can deduct the maximum amount while staying on the right side of the law.

What Medical Expenses are Deductible?

You can not only write off medical expenses for yourself and your spouse but for dependents as well. This includes a child or even a relative that you care for. You do not have to claim this person as a dependent in order to write off his or her expenses. For example, a parent who has less than fifty percent custody of his or her child usually does not claim that child on his or her taxes but still can deduct medical expenses that he or she personally paid.

Medical Tax Deductions

Medical Tax Deductions

You cannot deduct all medical expenses, although most will be covered. In general, you can only deduct expenses that you personally paid for. If your insurance plan or an employer paid, then this is not a deductible expense.

If you have a question, the detailed list of allowed deductions can be found in IRA Publication 502. Be sure to save receipts and itemized invoices for all things you plan to deduct. In addition, you should keep a record of who was paid, the amount, and the date, in addition to which person in the household needed the service. Good recordkeeping makes it easier to file taxes and can help you justify your deductions to the IRS if need be.

Tax Rules

Tax Rules

What Rules Govern Medical Deduction?

There are several rules that will affect your deductions. First, if you are under 65, you can only write off medical expenses that exceed ten percent of your adjusted gross income. In other words, the government considers ten percent of your income to be a “normal” medical budget but anything above that is tax deductible. If you are 65 or older, you can write off medical expenses that exceed 7.5 percent on your adjusted gross income.

While most people think that they spend less than these limits, this often is not the case. Medical expenditures are not just doctor’s visits and prescriptions. There actually are a lot of overlooked deductions.

Overlooked Deductions

Overlooked Deductions

Most Overlooked Medical Deductions

Most people do not get near their ten percent standard because they are not counting all of their medical expenses. These are the expenses that people are most likely to forget:

– Insurance premiums from taxed income, such as long-term care insurance
– Treatments and devices not covered by insurance, such as dentures and contact lenses
– Travel expenses associated with medical care, using the IRS mileage rates of 23.5 cents a mile
– Adaptive devices for special needs, including wheelchairs, mobility devices, closed-captioning on televisions, animal companions such as seeing eye dogs, and modifications to your vehicle and home
– Laser eye surgery
– Substance abuse treatment
– Transportation and admission costs to attend a conference for people with conditions suffered by you or someone in your household
– Smoking cessation programs
– Medically necessary diet programs

What Medical Costs are not Tax Deductible?

There are certain medical costs that are not tax deductible. These include home modifications that increase the value of your home, like elevators. Cosmetic procedures like electrolysis or anti-aging treatments are not covered either. Supplies that are not recommended by your doctor for health reasons – alternative remedies, for example – are also not covered.

Deductions NOT allowed

Deductions NOT allowed

Tips and Tricks for Increasing Medical Deductions

There are a few strategies that will allow many households to write off more medical expenses. In general, these fall under two categories: increasing medical expenses or decreasing adjusted gross income.

There are a few ways to “increase” medical expenses without paying more than you otherwise would. If you are already over or close to your ten percent, you can purchase medical services in December rather than January. This is especially helpful for people who plan to earn more or have fewer medical expenses next year. If you are short on money, you can even pay for these expenses with a credit card. Even though you will be actually paying for the credit card bills in 2015, you still can count these as a 2014 deduction if the purchase was made in this calendar year.

Reducing Taxes

Reducing Taxes

Reducing adjusted gross income is more complicated. Some people make donations to a health savings account, for example, or a 401(k). Sometimes even a small decrease in adjusted gross income can lead to a much larger amount of medical deductions. It’s important to run the numbers and see which strategies will save you the most money.

Medical expenses for the average family increase every year, to the point where they are currently a large burden for many households. It is important to get as many deductions as you can to lessen this huge and growing cost. While the laws are complex, it is possible for most families to get back some of their investment in their personal health and wellness.

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