Managed Care Organizations (MCO)

Issue:
A catch-all phrase encompassing a new way of coverage and payment for health care services. MCOs can range from strict HMOs to the concept of a prospective payment system. Basically, an MCO is anything but the old fee-for-service system (i.e. provide anything at any time, as often as wanted/needed and "someone else" pays for it). Managed care is vastly different from the current Medicare system. Medicare's system has effectively shut out RCPs from providing services in alternate care sites. MCOs seek to provide health care in the most appropriate and cost-effective site, which is not always in the hospital. Rather than a rigid Medicare laundry list of services, MCOs allow great leeway in what services should be covered.

AARC'S Position:
MCOs, in whatever form, are here to stay and they can provide vast opportunities for the employment of RCPs outside of the hospital. Unnecessary expensive hospitalization will be avoided by MCOs. They will embrace the most appropriate, cost-effective method of delivering health care services. Because RCP services provided outside the hospital prevent hospital readmissions, RCPs are more cost effective than other health care personnel. Therefore, MCOs should and are beginning to embrace using RCPs in alternate care sites. The AARC will continue to educate and market the RCP to managed care organizations.

What You Can Do:
Market to and educate local MCOs yourself. Managed care's structure is new and entirely different from the old fee-for-service system. You must take the initiative to convince any newly organized MCOs of the advantages-both in patient care and financial-of hiring RCPs.