Continuum Of Care Essay

In 2012, the ACA found an excessive amount of readmissions of patients that were hospitalized within 30 days for the same medical conditions. This factor viewed under the ACA as a quality issue and CMS implemented value-based incentive payments based on performance in a set of quality measures. The plan is to implement a pay for performance (P4P) in formulas used by Medicare to reimbursement providers. “The objective is to link reimbursement to quality and efficiency as an incentive to improve the quality of health care, as well as reduce system-wide costs” (Shi and Singh, 2015). In addition to the P4P, nonprofit hospitals also focus on continual improvement, data and cost containment throughout the organization (Adamopoulos,

The Affordable Care Act was enacted to improve health care and to lower health care cost in America. The ACA developed different strategies to meet these goals called the “pay for performance” programs. These strategies are aimed at the different providers to improve quality care. The strategy that I selected is the “Hospital Readmissions Reduction Program” this program/strategy is also known as the HRRP and was begun in October of 2012. HRRP is aimed at hospitals and penalizes hospitals that have a high 30 day readmission rate. The penalties are assessed and based on a number of comparisons, those such as, performance, patient demographics, comorbidities and frailty.

It may seem inevitable that high readmission rate is one of the challenges that an acute care setting is currently facing. According to studies, 20 percent of Medicare patients alone, get readmitted within 30 days of discharge. (Alper, E., O’Malley, T., & Grrenwald, J. 2017). Avoiding or preventing hospital readmission within 30 days of discharge can help Medicare save around $17 billion dollars yearly. (Morse, S. 2016). Understanding and getting to the root of why high re-admission rates still occur is highly important. Not only it will be cost effective but will also create a better well-being on the patients.

The pace of change throughout the healthcare industry has never been greater, due in large part to a growing emphasis on improving patient satisfaction, managing costs, and improving quality of care. This is referred to as the “triple aim” of healthcare reform. In fact, healthcare reform has directly and indirectly driven the development of accountable care models and many other quality initiatives such as episode-based payment and shared risk programs. As a result, hospital revenue is now increasingly tied to measures related to patient satisfaction, health outcomes, and compliance with evidence-based standards of care. For example, one third of Medicare payments to hospitals are now based on quality or value.¹ These include a growing portion

With the passage of the Affordable Care Act (ACA) in 2010 there have been significant changes in the healthcare environment in the United States. The ACA has a goal of increasing access to health care services while also reducing costs. Today’s “triple aim” of healthcare includes improved population health, better patient satisfaction, and lower patient costs.

With the law, hospitals have the opportunity to receive increased Medicare payments as long as they increase patient education about care after hospital discharge, provide patients with community healthcare resources, and increase discharge instructions for patients suffering from heart failure (Burton, 2012). The Centers for Medicare and Medicaid Services (CMS) has threatened to reduce hospital payments to one percent if the patient readmission rates of “heart failure, pneumonia, and myocardial infarction” increase past a certain limit (Burton, 2012). State Medicaid agencies will grant providers reimbursement if “comprehensive transitional care” is provided to patients (Burton, 2012). The law also offered $200 million towards projects aimed at increasing the number of advanced practicing nurses in areas including: chronic care, preventive care and primary care (Burton, 2012). Preventive care will allow nurses to reduce the rates of high acuity patients in their hospitals. If the PPACA fails to improve care transitions, the CMS plans to carry out other policies. These policies

Transition of care appeals to me the most in my practice as a case manager. When a patient gets admitted, the interdisciplinary team starts working on the discharge planning. I always wonder how can the team know for sure, that the patient is ready to be transitioned and how can we know for sure that the transition of care is safe and it would not be overlook?

The triad of cost, quality, and access has impacted the development of the Affordable Care Act on many levels. The Affordable Care Act aims to improve the quality of healthcare, while maintaining the cost of health care ("Quality of care," n.d.). Under the Affordable Care Act, there is more funding for each state to assist in treating people with chronic illness. The goal is for these patient populations to have high-quality services at an affordable cost (“Quality of care,” n.d.). To ensure that quality of care is provided, the Affordable Care Act requires quality measures to be met in order for organizations to receive reimbursement. Although the United States still needs improvement in providing high quality health care that is accessible

Drug and Alcohol Treatment in America has been based on the Medical Model of Treatment. According to Wikipedia, the medical model of addiction is rooted in the philosophy that addiction is a disease and has biological, neurological, genetic, and environmental sources of origin. Treatment includes potential detox with a 28 day or more stay at a residential treatment facility. The continuum of care can include an additional 28 days at the partial hospitalization level, followed by another 6 weeks of Intensive Outpatient.

Medicare has changed the way it pays hospitals for services delivered to clients with Medicare. Instead of only paying for the amount of services the hospital offers, Medicare also pays hospitals for providing top quality health care services. The Centers for Medicare and Medicaid Services (CMS), a federal agency that runs the Medicare program, is altering the way Medicare compensates for hospital care by giving rewards to those hospitals that delivers higher quality and higher value service to clients (Medicare.gov, n.d.). At the beginning of October 1, 2012, the Affordable Care Act (ACA) permits Medicare by reducing payments to acute care hospitals with surplus readmissions that are paid under CMS 's inpatient potential payment system (Medicare.gov, n.d.). Medicare has information regarding how the hospital 's quality care affects the disbursements it receives from Medicare. The Hospital Value-Based Purchasing (VBP) Program, created by the ACA,

One of the major goals of the ACA is to improve quality of care by using a value-based system. Nationwide, nearly 3,500 short-term acute-care hospitals are reimbursed under the Inpatient Prospective Payment System (IPPS). Within the IPPS is the Hospital Value-Based Purchasing Program is (VBP). This program “rewards acute care

Health care systems are refining their strategies in line with the changing market dynamics. These dynamics range from competitions to a change in the technological developments. It is worth noting that other than changes happening in the markets, the health care facilities have been highly impacted by changing legislations, such as the passing of the Affordable Care Act. Constantly evolving health care system calls for reevaluation of current strategies that have an impact on the quality of performance, as well as the value of the services offered to the clients. Historically, the reimbursement was driven by the volume rather than the value. Utilization of efficient transition of care, as a value-based care, will allow for overall cost savings, lower rate of readmission, and continuity of care. The purpose of this paper is to examine the utilization of strategies to enhance the transition of care, as a value-based care.

Two recommendations that align with the aforementioned solutions are to shift the focus of health care from acute care to chronic care, and implement sustainable disease surveillance systems.

Person-Centered Care Patient-centered care is based on your health care needs as a whole. The aim is to provide you to be more involved in your care. This means that all health care providers require good communication skills to successfully meet your needs to the best possible standard, in a safe and respectful way (Reynolds, 2009). Person-centered Care consists of providing you with dignity, respect and compassion and ensure that human rights that are cherished within the NHS and towards your care. It also means ensuring that coroneted care, treatment and support is being offered to you throughout your care.

This essay is based on the Case study of a patient named as Mrs Ford. It will be written as a logical account, adopting a problem solving approach to her care. She is elderly and has been admitted onto a medical ward in the hospital, following a stroke. This essay analyses the care that she will receive and focuses on the use of assessment tools in practice. Interventions will be put in place directly relating to the assessment feedback and in line with best practice.