...Pay-for-performance and Reimbursement Jason Teker HCS/531 May 2, 2016 Georgetta Baptist Pay-for-performance and Reimbursement Health care is in the middle of a change in how payment is received for services provided. Fee-for-service is the dominant form of reimbursement for hospitals and doctors. According to Medicaid’s website, the fee-for-service payment model is structured so that there are incentives in place based on the number of services provided. Fee-for-Service models allow for a system where quantity is more important than quality. With rising health care costs, the federal government is looking to change the way hospitals and doctors are reimbursed for their services. Quality health care is becoming a hot topic in many realms of the health care industry. The government has proposed a new form of repayment in a system called Pay-for-performance which was brought to the forefront of policy agendas by the Institute of Medicine’s (IOM) report in 2000 titled To Err is Human (Mayes, 2006). In the report, the IOM estimated “as many as 98,000 patients die annually in U.S. hospitals due to preventable medical errors” (Mayes, 2006, p.17). Pay-for-performance is “a reimbursement method under which some physicians and hospitals are paid more than others for the same services because they have been deemed to deliver better quality care and their patients appear to have better outcomes” (Mayes, 2006, p.17). With this new reimbursement method, the incentives are now...
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...Pay-for-Performance HCS/531 January 28, 2013 Jody Sklar Pay-for-Performance Emergence of Pay-for-Performance In 2000, the Institute of Medicine (IOM) released the report “To Err is Human: Building a Safer Health System.” The report catalyzed the attention of health care stakeholder groups in the nation (Stafford, 2000). The research provided a comprehensive, detailed account of health care errors and preventable deaths costing billions of unnecessary dollars in a health care system already spiraling out of control. The IOM recommended that Congress create a Center for Patient Safety within the Agency for Health Care Research and Quality for the purpose of designing a safer health care delivery system. Fifteen months after releasing the patient safety report, the IOM released “Crossing the Quality Chasm.” The report framed underlying reform necessary in the current health care delivery system to ensure patient safety. The framework sought to hold providers accountability for the quality of care they deliver. The introduction of the pay for performance (P4P) as opposed to the prior fee for service and prospective reimbursement guidelines induces delivery of care based upon performance measures. Broadly defined pay-for- performance includes any type of performance-based provider payment arrangements, including those that target performance on cost measures (U.S. Department of Health & Human Services, 2006) Reimbursement Pay-for-performance, synonymous...
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...Patient Safety/Quality Care/Improvement Case Study The Patient Safety defines health errors as “the disappointment of a designed action to be finished as planned or the use of an incorrect plan to attain an aim(Longo, D., Hewitt, J. E., Ge, B., & Schubert, S., 2007).” Health errors do not all effect in damage or grievance. Checkup errors that reason damage or hurt are occasionally called avoidable unpleasant actions that are the damage is a reflection to be due to a therapeutic intervention, not principal patient circumstances. Errors consequential in severe injury or death are considered “sentinel events” by the Joint Commission (Longo, D., Hewitt, J. E., Ge, B., & Schubert, S., 2007). The case study, Appearance May Not is Reality, was the focus of this assignment because of privacy practices. The purpose of this assignment was to identify key ethical and legal issues, determine which elements of the Code of Ethics of the American College of Healthcare Executives (ACHE) would help administrators determine the right course of action, identify potential ethics committee actions, and administrator’s role in preventing and addressing the issues in the aforementioned case study. Protected Health Information is the information that you provide us or we create receive about your health care. PHI contains a patient’s age, race, sex, and other personal health information that may identify the patient (Nationwide Children’s Hospital, 2013). The information relates to the patient’s...
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...Affordable Care Act: Impact on Providers Quality vs. Quantity Abstract The Affordable Care Act’s proposal was to make sure that health insurance coverage is affordable for individuals, families, and businesses and decrease the amount of uninsured individuals. . Much of the impact of this act will begin when the major coverage provisions take effect in 2014. Providers will experience an increased burden in many aspects of their medical profession including new legal practicing liabilities, less autonomy, administrative encumbrances, shortages of primary care physicians, and political infringement (Horton, Hollier 2012). The provider is to maintain high quality of care while the ACA’s agenda is cost and quantity over quality. The Affordable Care Act is the largest piece of legislative reform in American history relating to health care. The impact to our economy on many levels of scale and our constitutional rights are all being questioned and debated without a definitive answer to long term reality of its implications. Reform is necessitous to the continuance of providing care, controlling fraudulent activities and waste, as well as, exploring new innovative ways to maintain a high level of quality services within the legalities of our legislative branch. The balance of these aspects have been challenging and perplexing in materializing the reforms into fruition. The concentration during reform has been on quantity of the insured population...
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...examine the importance of the Nurse’s skills in the medical field. Identifying the role of the nurse in the care of the patient, the essential competency skills to develop an emotional intelligent nurse will be analyzed including intellectual skills, self-awareness, therapeutic and teaching skills, listening, and, probing skills (Xavier & Pereira, 2012). The process of these developments will be evaluated to assess for any improvement needed to achieve the desired emotional intellect outcome. Emotional Skills of the Nurse Competency in Nursing is a necessary element when caring for patients. The nurse demonstrates confidence in his or her knowledge and ability while acting with genuine empathy for the community served. She or he has studied medicine for years before beginning his or her career in nursing and has mastered the medical skills necessary to become successful. Nurses serve a diverse community with individuals of different languages, ethnicity, religious beliefs, and sexual orientation. The nurse can resolve conflicts and recognize the views and values of others while not judgmental of the differences of those he or she disagrees with. The nurse understands the importance of emotional intelligence because before one can understand others he or she must first understand oneself (Goleman, 1995). The nurse administers medication meticulously and with care. The medical professional requires the competencies of emotional intelligence because emotional state plays...
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...Health Care Provider and Faith Diversity: First Draft Shelly Morrow Grand Canyon University Spirituality in Health Care HLT-310V August 30, 2014 Abstract BACKGROUND: To care for a patient in a holistic manner requires one to be able to adapt to the diversity of faiths encountered as well as providing spiritual support as per the patient’s faith. OBJECTIVES: This paper aims at exploring three less well-known faiths and compare the philosophy of providing health care from the perspective of those faiths. The philosophies of the Amish, Jehovah’s Witnesses, and the Christian Science faiths will be compared as well as reviewing how these faiths compare to that of the other diverse Christian faiths and that of this writer’s personal beliefs. CONCLUSION/RELEVANCE TO NURSING CARE: It is found that if a health care provider is spiritually sound and open to providing that holistic care to a patient of any faith, one will find that this meets the needs of those patients with beliefs different than that of the health care provider. Health Care Provider and Faith Diversity: First Draft In order to administer the highest degree of holistic care to patients, health care providers need to have an understanding of the many different faiths and cultures encountered on a day to day basis. A survey of churches and religions has shown that there are 19 major world religions with 34,000 separate Christian groups recognized throughout the world. There are varying definitions...
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...measures which are required… I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.” The Hippocratic Oath is a powerful document, binding medical practitioners to a certain set of morals they must adhere to when assisting their patients on matters of life and death. With so much at stake, nothing should come between a doctor and his responsibility to his patient as defined by this document - in theory. However, there is always one uncertainty that tarnishes this idealistic dedication of the physician:...
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...Future for Health TO ERR IS HUMAN: BUILDING A SAFER HEALTH SYSTEM H ealth care in the United States is not as safe as it should be--and can be. At least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been prevented, according to estimates from two major studies. Even using the lower estimate, preventable medical errors in hospitals exceed attributable deaths to such feared threats as motor-vehicle wrecks, breast cancer, and AIDS. Medical errors can be defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. Among the problems that commonly occur during the course of providing health care are adverse drug events and improper transfusions, surgical injuries and wrong-site surgery, suicides, restraint-related injuries or death, falls, burns, pressure ulcers, and mistaken patient identities. High error rates with serious consequences are most likely to occur in intensive care units, operating rooms, and emergency departments. Beyond their cost in human lives, preventable medical errors exact other significant tolls. They have been estimated to result in total costs (in cluding the expense of additional care necessitated by the errors, lost income and household productivity, and disability) of between $17 billion and $29 billion per year in hospitals nationwide. Errors also are costly in terms of loss of trust in the health care system by...
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...Health Reform Project, Part One Learning Team C HCS 440 Economics: The Financing of Health Care Medical Care for an Aging Population Countries around the world are encountering a growing number of the elder demographic. The aging population has created situations that the world’s economy and health care that have never encountered. The elders leaving the workforce and entering retirement has created new challenges in an already fragile global economy and health care system, and it is uncertain what the impact will in America. Questions rose about how the aging population will affect the economy. Will these changes bring new opportunities for the aging population because of the healthier life style and longer life expectancies currently seen today? Will physically and mentally healthier seniors be able to manage longer working years? Alternatively, will it result in a shortage of worker in the workforce leaving an overwhelming burden on the younger population? This paper summarizes three articles that attempt to bring to light the various challenges the nation is encountering in its preparation to care for the aging population. Additionally it will provide the readers with some recommendations on strategies both the American industries and government can use to prepare for the loss of a large percentage of the workforce who will start retiring in the next decade. The burden of geriatric health issues While countries across the globe are scrambling to make the...
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...treatment and prevention. This, along with other factors, creates poor patient care and vast costs to the pertinent facilities. The solution is to have interprofessional collaboration. The utilization of current advanced practice nursing staff as a resource for floor nurses and other involved healthcare workers is a must. This would obtain certification in wound care and be responsible for the ongoing continued education for wound prevention, monitoring and maintenance. The staff will be educated and trained at quarterly intervals on wound identification, staging, prevention, maintenance and monitoring. Key words: wound care, evaluation, pressure ulcers, multidisciplinary, specialist, evidence The Significance of Having a Multidisciplinary Team 4 Problem Identified The Centers for Medicare & Medicaid Services (CMS) declared in October of 2008 that it will no longer provide reimbursement for hospital acquired pressure ulcers (HAPUs) because it is a preventable occurrence (CMS, 2014). Even though the percentages of occurrences have declined since then, HAPUs continue to cause financial strain on institutions (estimated $9.1- $11.6 billion dollars loss annually) (Leaf Healthcare Inc., 2014). Nurses are in a position to decrease these numbers but barriers remain. Staff nurses in acute care settings, as well as hospital based transitional units provide care for patients with multiple diagnoses. These nurses are required to identify potential...
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...Jane Atim, MBChB, MPH Uganda Health Marketing Group (UHMG) Stephanie Cantu Harvard Medical School Jonelle Wright, PhD, RN University of Miami Introduction This module consists of four (4) sections. After completing the training, you will take a short quiz on the training content. After completing the quiz, we ask you to answer a few optional questions to give your view of this training module. Learning Objectives By the end of this module, you should be able to: Describe the concept of Cultural Competence in Research Explain the importance of Cultural Competence in Research Describe ways to enhance the engagement of diverse populations and communities in research Identify cultural competence challenges faced by researchers when working with culturally diverse populations Cultural Competence in Research Culture is fundamental to everyone's perceived identity. It is a mix of one's values, beliefs, standards, norms, behaviors, language, communication styles, and thinking patterns.[1] Cultural competence refers to understanding the importance of social and cultural influence on the beliefs and behaviors of the patient, student, colleague or client.[2] Cultural competence in health care describes the ability of systems and health care professionals to provide high quality care to patients with diverse backgrounds, values, beliefs, and behaviors, including communicating effectively and tailoring delivery to meet patients' social, cultural and linguistic...
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...and enjoy it to its fullest. This dream has been made obtainable with modern medicines, treatments, and the availability of said things. America holds about four percent of the world's population, and it ranks third in the world for most populated country; however, it has failed to ensure the safety and health of its populace and has made the cost of living almost as unattainable as immortality. This problem could be fixed with a simple solution that has been proven to increase quality of life: Universal Healthcare. Many Americans do not see a need for universal healthcare. It is true that America has survived long enough without Universal Healthcare, but that does not mean it would not...
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...Jessica Rose December 13, 2015 Student ID# 277419 XTT Task 1 BSN to MSN A Currently in my facility, we do not have a policy regarding geriatric and/or demented patients and pain control. I believe this needs to be changed because although we have an initial assessment protocol, we do not have any kind of protocol to control a geriatric or demented patients pain. Since demented patients are quite often left unable to communicate their feelings, I believe there would be, less adverse effects and better patient outcomes for this group of people and better satisfaction with their families. B There are many people associated with proposing the change within the facility. First would be to go through the assistant nurse manager and nurse manager who would then bring the proposal to the nursing and medical directors for the ER. The ANM and NM would have to decide whether the proposed change would be beneficial for the patients and their outcomes and do further research which they would then propose to the directors. From there, they would decide whether the research was sufficient enough to implement a change. C Full APA citation for at least 5 sources | Evidence Strength (1-7) and Evidence Hierarchy | 1. H., Bell, J., Karttunen, N. M., Nykänen, I. A., M., & Hartikainen, S. A. (2013). Analgesic Use and Frailty among Community-Dwelling Older People. Drugs & Aging, 30(2), 129-136. doi:10.1007/s40266-012-0046-8 | 2 and Experimental | ...
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...Institute for Health Technology Transformation Population Health Management A Roadmap for Provider-Based Automation in a New Era of Healthcare Acknowledgements Alide Chase, MS Senior Vice President for Quality and Service Kaiser Foundation Health Plan, Inc. & Kaiser Foundation Hospitals Connie White Delaney, PhD, RN, FAAN, FACMI School of Nursing Professor & Dean Academic Health Center Director, Biomedical Health Informatics (BMHI) Acting Director of the Institute for Health Informatics (IHI) University of Minnesota Don Fetterolf, MD, MBA Principal Fetterolf Healthcare Consulting Robert Fortini VP & Chief Clinical Officer Bon Secours Health System Paul Grundy, MD, MPH Global Director of Healthcare Transformation IBM President Patient-Centered Primary Care Collaborative Richard Hodach, MD, PHD, MPH Chief Medical Officer Phytel Michael B. Matthews Chief Executive Officer Central Virginia Health Network Margaret O’Kane President National Committee for Quality Assurance Andy Steele, MD, MPH, MSC Director, Medical Informatics Denver Health 2 Dear Colleagues, Population health management has been around for a while, but only recently has it gained serious attention from mainstream healthcare organizations. The reason is simple: healthcare reimbursement is changing, and hospitals, healthcare systems, and physician groups must adapt to a new world in which providers are rewarded for meeting quality objectives for their entire patient panel, and not just those actively...
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...Decline in Employee Morale and Job Satisfaction: UHS Decline in Employee Morale and Job Satisfaction: UHS Established in 1978 United Health Services has deemed itself as a top standing healthcare management corporation. For the past thirty two years the company has expanded operating through affiliate hospitals, behavioral health facilities and ambulatory centers nationwide. The organization has been ranked as one of the top “Fortune 500 “largest corporations for 2011. With all of the accolades and successful growth it would be difficult to point out any discrepancies that the organization could have as it relates to organizational behavior. The company has progressed from several facilities in 1978 to a conglomerate of facilities in the millennium. The organization is the 5th largest for profit hospital managed Health Care Company that is currently competing with increased growth in the Physician owned facilities. The company is the largest publicly known trader of psychiatric and substance abuse facilities. What meaning does these accomplishments mean when they have prospered and flourished to the extent that it exceeds the expectations of the business owner but on many levels fail to meet expectations of the employees and the patients. When evaluating the company success there is no doubt the intangible business decisions have led them to acquire a great deal of recognition as a franchise. Many would argue that a franchise should be more than for profit when it comes to...
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