Healthcare Policy and Law
Accountable Care Organizations (ACOs) refer to a group of medics and healthcare providers that voluntarily united to improve and provide quality healthcare services to Medicare patients. Their goal is to promote coordination in healthcare provision and ensure that the patients access medical care at the right time, avoid duplication of medical services, and avoid medical errors.
ACOs were developed as a result of the implementation of the Affordable Care Act, in 2010 which sought to increase the quality of healthcare services, reduce the cost of medical provisions, and account for the rising population, ensuring everyone has access to healthcare facilities. This provision has brought many benefits to the healthcare industry, such as preventing diseases and promoting wellness. ACOs have also contributed to stronger population health and the reduction of disease progression.
On the patient’s side, ACO’s have increased their confidence in the healthcare system through improved outcomes and results, better quality healthcare, improved interactions with the healthcare providers, and improvement of healthcare contribution. However, ACOs came with a significant disadvantage: the increased competition with other organizations that seek to harm patients by providing low-quality healthcare services at a higher cost. To tackle this issue, the agencies have developed the Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program, otherwise known as the policy statement. This policy statement describes the ACOs to which the policy will apply, when the agencies are to apply the role of reason to these ACOs, the antitrust safety zone, and additional antitrust safety guidelines, applicable to ACOs outside the safety zone.
Antitrust issues in the healthcare industry arise when competitors (of ACOS in this case) use the relevant information acquired about the ACO’s operations to control the price of healthcare services, the quality of healthcare provided, and the access of the healthcare services to the patient. These factors restrict healthy competition within the industry.
Antitrust laws have been operational since the first law concerning this issue was implemented in 1914, the Clayton Antitrust act. This Act has provided grounds for argument and judgment of various competition cases, not necessarily in the medical industry, such as The United States vs. Microsoft Corporation case of 2001. Antitrust laws are important in the United States’ healthcare system to regulate the increased competition between hospitals, physicians, and insurance providers. Hospitals are experiencing declining demand, and their competition results from technology and the medical provisions in each hospital, such as diagnostic and surgical centers. Insurance competition is dependent on the hospitals’ development, their conditions, and the services offered that allow them to partner with insurers. The financial future of the ACOs and Medicare is dependent on the Antitrust rules, hence the provision of the policy statement. The antitrust laws are enforced, and they impact the development of the healthcare industry.
The student’s opinion on how this issue should be handled is that the government should put more effort into enforcing the law to maintain healthy competition in both the hospital field and the insurers market and lead the development of new market and development in this area. The policymakers and enforcers should implement these antitrust laws by including activities that incorporate the ideas of healthy competition as well as competition regulations. This can be achieved by establishing standard and regulated prices in hospitals and healthcare facilities and providing competition models that include the entire insurance market.
I believe Accountable Care Organizations continue to grow over the years. Their lucrative goals and objectives have attracted many supporters and financers of their cause. They have attracted many medical practitioners who volunteer to provide quality healthcare to patients at an affordable cost. ACOs have improved the consumer’s review of the healthcare system due to their increased satisfaction.