Clarice Miller; Accountable Care Organizations and Occupational Therapy. Am J Occup Ther 2018;72(5):7205090010p1-7205090010p6. doi: 10.5014/ajot.2018.725003.
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© 2019 American Occupational Therapy Association
Accountable care organizations (ACOs) are organized networks or systems that provide services to Medicare beneficiaries under the Patient Protection and Affordable Care Act of 2010 with an emphasis on chronic care management. ACOs were instituted under Medicare to achieve value-based purchasing as opposed to simply providing high-volume, fee-for-service care. ACOs must reduce annual care expenditures through Medicare-covered services. Occupational therapy services often play a role along the care continuum of an ACO. This article examines some of the opportunities for occupational therapy to contribute to ACO quality outcomes and value-based care and considers some barriers for full utilization of occupational therapy practitioners in alternative payment models. Evidence-based and client-centered care provided by occupational therapy practitioners can result in increased inclusion of occupational therapy as a valued component of ACOs and other value-based service models.
ACOs are groups of doctors, hospitals, and other health care providers who come together voluntarily to provide coordinated high-quality care to their Medicare patients.
The goal of coordinated care is to ensure that patients get the right care at the right time while avoiding unnecessary duplication of services and preventing medical errors.
When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings it achieves for the Medicare program.
ACO-13: Falls—screening for future fall risk
ACO-16: Preventive care and screening—body mass index screening and follow-up
ACO-17: Preventive care and screening—tobacco use, screening and cessation intervention
ACO-18: Preventive care and screening—screening for clinical depression and follow-up plan
ACO-28: Hypertension—Controlling high blood pressure
ACO-35: Skilled Nursing Facility 30-Day All-Cause Readmission measure (Smith et al., 2017)
ACO-36: Unplanned admission for patients with diabetes
ACO-37: Unplanned admission for patients with heart failure
ACO-38: Unplanned admissions for patients with multiple chronic conditions
ACO-40: Depression remission at 12 mo.
occupational therapy practitioners can play an integral role in ACOs by utilizing their unique skills and qualifications: Assessments can focus on the improvement of a patient’s quality of life and include evaluations of home safety, [activities of daily living and instrumental activities of daily living], participation, vision, ergonomics, driving, fall risk, swallowing, pediatric, and mental health. (p. 1)
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