Can the ACO reform help reverse this trend?

Can the ACO reform help reverse this trend?

It is expected that with the policy reform in payment model linked with the ACA/ACO, these trends [what trends?] can be reversed. The contractual agreement through the ACO with CMS and possibly private insurers with associated profit or gain sharing will help reverse these pitfalls in accounts receivable [such as?]. The bundled payment method and VBP payment method if fully implemented will lead to additional source of revenue over the Capitation method of reimbursement currently used at Gotham. This in addition to the extra revenue generated through gain sharing are sources of income to Gotham that can substantially improve the account receivable, predicated on the assumption that the Integrated ACO structure will be efficient in patient management through coordinated care. This will improve Gotham financial standing. Accordingly, Gotham will need to coordinate with associated Providers in the ACO unit to continually look for creative and innovative ways to improve patient care in order to benefit from the cost sharing.

Moreover, the ACA which ensures individual mandate by 2014 leading to increased coverage will result in more revenues for Gotham. This mandate requires that all Americans purchase insurance coverage. This will lead to increased number of insured patients which are potential enrollees that will be requiring medical care and services by the providers within the Gotham ACO integrated structure. This potential patient’s pool also constitutes a potential source of revenue that will increase account receivable.

However, the team is of the opinion that more time is needed post ACA implementation to be able to measure any significant impact the policy changes has on Gotham Hospital and its patient population in general and diabetes patient in particular.

The biggest Post-ACA issue the hospital has to deal with is the low reimbursement rates and the increase in coverage. According to the ACA provision, Gotham Hospital will have to conduct Community Health Need Assessments (CHNA) every three years, make new requirements for financial grants (to help patients pay for the cost of medical care) and the most direct threat to Gotham, is that they cannot immediately take collection action against patients that cannot pay. CHNA has important implications to the underinsured and uninsured in the Bronx community as Gotham hospital has to establish it in order to render the needed services to these cohorts of the population. Thus, the ACO provision provides an opportunity for the uninsured and underinsured to have increased access to healthcare. However the challenge still remains how to get this group of patients to access the services made available to them by Gotham hospital. The group strongly advocates the use of local coordinators to bring about increased access to this group of patients.


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