C799 Performance Assessment Task 1

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Western Governors University *

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C799

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Health Science

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Jan 9, 2024

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C799 Healthcare Ecosystems Performance Assessment Task 1 Lindsay McGahee C799: Healthcare Ecosystems Tricia Jones May 8, 2023

A. Medicare Certification – Conditions of Participation Medicare certification impacts healthcare delivery systems by requiring that providers are Medicare- certified to receive any Medicare and Medicare reimbursement. To achieve certification by Medicare, providers and facilities must demonstrate compliance with the Conditions of Participation. The Conditions of Participation are a set of requirements set forth by CMS that have varying tasks dependent on the healthcare delivery system and setting. (Oachs and Watters, 2020, p. 29-30) A1. Difference between Accreditation and Licensing for Healthcare Organizations Licensing is a legal requirement for a healthcare organization or provider to operate and provide care. Accreditation is voluntary and typically governed by an independent body to evaluate the quality of work being performed against predetermined standards. (Oachs and Watters, 2020, p. 1009) B. Relationship Between a Quality Reporting System and Reimbursement for Healthcare Services A quality reporting system is essential when participating in reimbursement plans such as Value-Based Payments. Value-Based Payments either rewards or penalizes providers and facilities based on the quality of care they provide. It is important to keep a good reporting system, such as Hospital Inpatient Quality Reporting, to see the correlations between quality of care and patient outcomes, along with the reimbursement levels for each evaluation. (Oachs and Watters, 2020, p. 28) An example of a Value-Based Care system is the Hospital Value-Based Purchasing (VBP) Program. This program rewards hospitals with adjusted incentive payments according to the Inpatient Prospective Payment System (IPPS). This program is based on the quality of care delivered to patients. It measures factors such as mortality, complications, healthcare-associated infections, patient safety, patient experience, and efficiency and cost reduction. These elements are measured on a two point system based on achievement and improvement levels. Whichever of the two scores higher is awarded the

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