The Delivery System, Medicaid, and Medicare

Hospitals and doctors are reimbursed for their services under the new Medicare payment scheme divided into two sections. The first component is hospital insurance, which is funded mainly by payroll taxes and has no premium for most of its recipients. The second component is medical care, typically covered by annual premiums charged by both the federal government and the beneficiaries. The payment of hospitals and physicians under the Medicare system is based on a fee set to apply to chiropractors, optometrists, nurse practitioners, physician assistants, and podiatrists (Scarrow, 2010).
The fee that Medicare reimburses consists of three primary structures that include; the value for the related service provided, the convection factor of the dollar and also the GPCL. The cost of service is comprised of the physician’s component of work, the expense of the component practiced and the component’s malpractice expense. The accounts of GPCI have costs variation to the medical practice. The national factor for the conversation of the dollar is used to convert the value of the related service to the amount of the currency. Therefore, each physician has a CPT code, and Medicare pays for these services since they are system based.
Medicare reimburses hospitals and physicians with lump sum payment for the services that they have provided to Medicare beneficiaries. Insurance companies that act as fiscal intermediaries and carriers process any Medicare claims. However, charges are directly related to the physician from the insurance company. When a hospital or physician accepts the assignment, not more than 15% can be charged to the Medicare because the system does not allow any charges above 15%. Medicare only allows an excess charge of 5% of what the physician would charge. Hospitals and physicians could also enter into a private written contract with Medicare eligible patients agreeing not to charge services covered by Medicare (Scarrow, 2010).  
What is Medicaid, what it covers, and how Physicians are reimbursed
The Medicaid is a joint state and federal program that is collaborated with the insurance that covers children to provide the health coverage to everybody including pregnant women, children, parents and individuals with disabilities. In the United States, Medicaid is considered one of the largest sources of health coverage. For one to engage in the Medicaid cover, it requires federal states to create insurance cover. Ideally, the federal states usually provide the cover to eligible groups like, individuals who receive the SSI (Supplemental Security cover), low-income families and qualified children and pregnant women.
The physicians out of these systems are usually paid through three components; the GPCI (Geographic practice cost indices), the conservation factor of the national value and the value of the service provided (Glass 92). The relative value of the services rendered is usually composed of the measure of time of the physician & skills and the intensity of the service provided. In normal circumstances, the components account about 54.4% of the value of duty. The expense of the component practiced relates to the average expense practiced such as the employee wages and office rents. Ideally, they are varied under code-by-code basis which depends on the service performed either in a non-facility or facility settings. Thirdly, the expense of malpractice that is reflected in the average insurance accounts for about 3.2% of the related service provided. Therefore the GPCI account is designed to variate the cost of practicing medicine. There is also a determination of a separate GPCI where the hours worked is considered to the physicians also to the medical equipment’s, office rents and also the miscellaneous expenses (Glass 121).
How ACOS is reimbursed under the Proposed Medicare Rule of the ACO rule
The ACOS authorizes the Medicaid and the Medicare services to have contracts with ACOs to ensure that ACOs work to improve the health of Medicare enrollees while constraining costs and in so doing, earn annual bonuses. ACOs replace the current Medicare payment system whereby hospitals and physicians are reimbursed through a lump sum for their services. Through the Affordable Care Act, ACOs enter into a contract with Medicare and takes care of all the medical needs of a group of patients and Medicare pay the ACOs based on the medical outcomes, patient satisfaction, and cost (Drew, 2011). 
In this new system, ACOs provide value versus volume when it comes to health care provision. A group of physicians and a hospital can share the responsibility of providing care to a group of patients whether inside or outside the hospital. Medicare also requires ACOs to have cost-containment incentives. ACOs have to be managed by hospitals or groups of doctors without involving insurers, and patients cannot be fined for seeking care outside the ACO (Faguet 154). The CMS just would not reimburse ACOs if they do not attain these quality metrics. The ACOs receive payment for their services whereby each physician or provider under the ACO is paid on a fee for service basis. 
If the providers have met certain quality metrics or objectives, then additional bonus payments are made. This is through the Medicare Shared Savings Program which enables ACOs to receive 50-60% of bonuses from what they have been able to save through cost-saving incentives. The bonuses that ACOs receive are reduced at 10-15% of their spending budget. For those ACOs that decide to pay back amounts that exceed their spending projections, then their shared losses are cut at 10% of its expenditure target and are given three years to complete the payments (Drew, 2011).
My Opinion concerning the success of the Proposed ACOS and factors that justify my Answers
The success rate of the proposed Affordable Act Care has led to a fundamental overhaul of the Medicare system including focusing on leadership and cultural change, hiring experienced healthcare professionals, and matching the payment model with quality. Since ACOs are new systems that are using different payment models from what was being used before, it is necessary to focus on leadership and cultural change in ACOs. The first factor would be changing the systems and payment models because it is common to find people struggling to understand the meaning and importance of the new arrangements. Such leaders would lead initiatives to make the medical staff understand the system, and this would contribute to the success of ACOs (Brimmer, 2013). 
The second factor would be through the hiring experienced healthcare professionals to the success of ACOs. Having health care staff that helps patients manage their health according to the Affordable Care Act can assist the transition to ACOs to move faster. Having staff with skills is also essential to drive cultural change among health care providers. 
Matching the new payment model with quality is the third factor that would enhance the success of ACOs. Health care providers have to invest in the payment structures and arrangements needed to embrace the new care delivery model. As much as health care providers have to improve quality, they do not have to reduce the fee for service business. This is because such moves would increase costs leading to lost revenues. Health care providers just need to invest in the right type of infrastructure in line with the new payment system (Brimmer, 2013). 


References
Brimmer, K. (2013). The keys to ACO success: Healthcare leaders discuss the ACO keys to success. Healthcare Finance. Retrieved on May 23, 2017 from http://www.healthcarefinancenews.com/news/healthcare-leaders-discuss-aco-keys-success 
 Drew, C. (2011). CMS Issues Proposed Rule on Accountable Care Organizations. Health Capital, 4(4). Retrieved on May 23, 2017 from http://www.healthcapital.com/hcc/newsletter/04_11/aco.pdf 
Faguet, G. B. (2013). A Missed Opportunity, a Better Way Forward. The Affordable Care Act, 110-293.
Glass, K. P. (2013). Applications for Medical Practice Success. RVU's Medical Group Management Assn, 89-220.
Scarrow, A. (2010). Physician Reimbursement under Medicare. Neurosurgical Focus 12(4). Retrieved on May 23, 2017 from http://www.medscape.com/viewarticle/433293_2