The Success or Failure of Medicare Affordable Care Organizations in Florida May Depend on owning a V
The Success or Failure of Medicare Affordable Care Organizations in Florida May Depend on owning a Vacation Home.
The Patient and Protection Affordable Care Act (ACA) was designed to improve the health care delivery system through incentives to enhance quality, improve beneficiary outcomes and increase value of care. One of these key delivery system reforms is the encouragement of Accountable Care Organizations (ACOs). ACOs are intended to facilitate coordination and cooperation among providers to improve the quality of care for Medicare Fee-For-Service (FFS) beneficiaries and reduce unnecessary costs through the Centers for Medicare & Medicaid Services (CMS) implementation of a Medicare Shared Savings Program (Shared Savings Program). Eligible providers, hospitals, and suppliers may participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO). Primary Care Providers (PCP) are incentivized to deliver care to their patient’s through the concept of the “Patient-Centered Medical Home”, a holistic approach emphasizing preventative intervention, while seeking to reduce medical expenditures through the elimination of unnecessary tests and medical services. However, patients are free to seek care outside of the structure of the ACO. If they do so, the providers of such services are not likely to have the same cost savings incentive as the ACO providers. In this situation, the ACO will be unable to control medical costs.
Florida providers have the additional challenge of dealing with the large representation of seasonal residents (“Snow Birds”) who spend a good part of the year out of state at their vacation home. The medical care they receive while “up north” is also outside of the ACO network. Therefore, the Florida-based ACO medical provider is unlikely to be able to control medical costs in this setting either. The recent economic downturn has forced many Snow Birds to give up their second home. While this change has had a stabilizing effect on the ability of ACO PCP’s to manage medical costs, the success or failure of Medicare ACOs in Florida may still depend on the proportion of Snow Birds who continue to use discretionary income to travel north during each summer and fall.
Leslie Tar, Esq., LLM*
*Florida Health Law Attorneys, Florida Medical Board Defense Attorneys, Florida Medical License Defense Attorneys.
* Office location in Port Charlotte, Florida with service to Sarasota, Ft Myers, Naples, Tampa, Orlando, Vero Beach, West Palm Beach, Boca Raton, Ft Lauderdale, Miami, Gainesville, Tallahassee, Pensacola and throughout Florida and nationally.