OBJECTIVES:To determine the willingness of accountable care organizations (ACOs) to bear financial risk for the healthcare they provide. DESIGN AND METHODS:Structured interviews conducted between January and June 2012 with 57 ACOs led by hospitals and physician groups located throughout the United States. Findings are based on the 38 ACOs that were actively providing care under an ACO payment arrangement at the time of the interview. RESULTS:Among these ACOs, 71% cover a portion of their ACO population with contracts that put the ACOs at some financial risk, while 45% have risk-based contracts for their entire ACO population. Payments based on fee-for-service (FFS) billing still dominate, as 92% of ACOs use FFS-based billing for at least a portion of their ACO population and 71% are fully reimbursed using FFS-based billing. CONCLUSIONS:Under the auspices of an ACO, providers are accepting some financial risk for their accountable care patient population. There is still strong reliance on FFS-based billing methods as providers experiment with different payment models.

译文

目的:确定责任医疗组织(ACO)承担为其提供的医疗服务承担财务风险的意愿。
设计与方法:2012年1月至6月间对57个ACO(由美国各地的医院和医师小组领导)进行了结构化访谈。调查结果基于采访时根据ACO付款安排积极提供护理的38个ACO。
结果:在这些ACO中,有71%的合同覆盖了一部分ACO人群,使ACO承受了一定的财务风险,而45%的合同中有针对整个ACO人群的基于风险的合同。基于服务费(FFS)计费的付款仍然占主导地位,因为92%的ACO至少有一部分ACO人口使用基于FFS的计费,而71%的ACO使用基于FFS的计费完全偿还。
结论:在ACO的主持下,提供者正在为其负责的护理患者群体承担一些财务风险。由于提供商尝试使用不同的支付模型,因此仍然强烈依赖基于FFS的计费方法。

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