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Accountable Care Organizations: A Two Part Guide – Part Two

Billing for medical services is confusing enough, so read the second part of our guide on accountable care organizations (ACOs) to learn more about how they may affect you.

How would it be different for patients?

Although primary care doctors who are part of an ACO would be required to tell their patients (and physicians would likely want to refer patients to specialists and hospitals within the ACO network), patients would still be able to see doctors outside of the network without paying more, should they choose. If ACOs don’t meet standards, they won’t be able to share in any savings and could lose their contracts—so they will be under pressure to provide high quality care.

Should you consider an ACO?

What sets an ACO apart from other health maintenance organizations is that an ACO patient isn’t required to stay in the network. ACOs keep billing and collections at bay while avoiding HMO structural features that limit patient options.

Possible Downsides

In the midst of the rush to implement ACOs, health care economists warn that hospital mergers and provider consolidation will result. Health costs could rise as health systems are given more leverage in negotiations with insurers.

In terms of legal concerns, the U.S. Justice Department’s antitrust division has promised to provide an expedited antitrust review process for these doctor-hospital partnerships.

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