End Stage Renal Disease

Moreover, we see that some providers are focusing on what providers do and how they get reimbursed rather than what the patient needs, which is a focus that does not prioritize quality of care and therefore does not align with the Triple Aim framework. The problem presented regarding this matter is that the health care system lacks a patient-focused care of medical conditions that puts patients and their health needs first. For example, when we think of provider reimbursement, it is not in the patient’s best interest for the system to only have a simple fee-for-service structure. A structure like this one will only lead to an increase of health care expenses. Also, it fails to incentivize high-value service, which also does not align with the Triple Aim framework health care providers should go by. It is very crucial for the health care system in the United Stated to find a better balance between medical groups reimbursement and patients needs in order to reduce the risk of overutilization.

In the past several years, there have been several changes in economic policy at federal and state levels. The two economic policies that present to be the most precedent for healthcare leaders with concern to facility reimbursement are the Affordable Care Act (ACA) and the switch from volume to value reimbursement. First, there is the ACA policy, which have affected healthcare facilities and their reimbursement methods. In fact, ever since this policy was implemented, provider reimbursement has started to decrease in terms of fee-for-service payments (The Common-Wealth Fund, 2015). In other words, the intention of this policy was to provide budget relief to the government payers as well as giving providers an incentive to provider patients with great quality of care.

Medicare is the nation’s largest health insurance program. Generally, you are eligible for Medicare if you or your spouse worked for at least ten years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. Medicare-covered services include hospital insurance, inpatient hospital care, skilled nursing facility care, home health care, hospice care, and medical insurance (Medicare U.S.) With such an encompassing effect on the health insurance field, Medicare provides a haven for older individuals, and end-stage renal disease (ESRD) patients who require the best medical care for whatever possible reason. The only problem with this scenario is

The U.S. spends more resources on healthcare than any other nation. Yet, the The Commonwealth Fund (2014, para. 1) claim the U.S. health system consistently ranks last or near last relative to other industrialized nations regarding health outcomes. Consequently, insurance companies are adopting a value-based reimbursement system aimed at containing costs and improving clinical outcomes (U.S. Department of Health and Human Services, n.d., para. 35).

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

For patients with chronic conditions, costs, even with insurance, can add up very quickly with numerous doctor’s visits, emergency room visits, and hospital admissions. The CDC (2016), states, “Treating people with chronic diseases accounts for 86% of the nation’s health care costs” (Center of Disease Control and Prevention, 2016). Despite the amount of time and money spent preventing and treating

Historically, reimbursement has been Fee-For-Service (FFS): tied to volume of visits, hospitalizations, procedures, and tests. This reimbursement structure creates misaligned incentives and fragmented, suboptimal patient care resulting in burgeoning costs and a lack of focus on outcomes. As a result, CMS and the industry have been

For many countries such as Europe, care is allocated based on predetermined factors (Knickman & Kovner, 2015). For example, an individual may be meticulously examined from health history to their present state to determine whether they are approved for chemotherapy treatments. Allocating care, familiarly called rationing, allows countries to control expenses of health care (Stein, 2010). Based on numbers, the United States tops Europe by double of the amount of patients they see for dialysis treatments (Knickman & Kovner, 2015, p. 265). Withinn the United States, as long as the services are in the guidelines of policy to provide care, Medicare is going to cover those services no matter the

The option that is most frequently used to treat the disease is dialysis. Dialysis takes a person blood and passes it through an artificial dialyzer which removes toxins and extra fluids from the patient’s blood. In addition to the “Core curriculum for the dialysis technician: a comprehensive review of hemodialysis” dialysis can be done in centers or at the patient’s own home, most of the time it’s done in centers three times a week for four hours.

One of the first things that we learn about Enid is that she must be a good nurse. The first paragraph on page 31 is full of observations that a nurse would make. She notes the coloration of Mrs. Quinn’s urine, which is an indication of the condition of her failing kidneys. She also observes the smell of her patient’s breath and the stains on her body. These are all signs that give her some idea of how much time Mrs. Quinn has before dying as well as her mental state.

There are many Chronic Renal Failure patients who are elderly and have additional diseases, such as diabetes, chronic pain, and others. Many of these patients have to wait as much as an hour to an hour and a half before and after treatments. The lack of policy and the absence of close management of this schedule may potentially put at risk patients in greater danger. Instead of patients being in the clinic

Traditionally the American health care system relied heavily a repayment model referred to as fee-for-service which is described as a form of repayment that generates a greater emphasis on the volume of patients seen rather than healthy outcomes produced under a physician’s care. The fee-for-service repayment method poses multiple issues such as: duplicating services which in turn renders some of the services unnecessary, utilization of expensive technology because of the revenue generation rather than as a valuable diagnostic tool and crowding caseloads to an unmanageable level in order to achieve highest level of reimbursement. The aforementioned events not only have the possibility of being unethical but also drive up the cost of health care in the United States. Currently, health care costs have not only increased, but the Office of the Actuary projected that U.S. healthcare spending will make up nearly 20 percent of the economy in 2019. One would argue that if as a country we are spending so much on health care that we should be a “healthier” nation, but this is not the case. Even though America continues to be the largest spender on health care, collectively we experience a lower life expectancy rate compared to other industrialized countries (hfma.com, 2011, p. 2). To assist with climbing health care rates healthcare purchasers have called for repayment reform. One such reform that has been on the forefront is Value-Based Health Care (VBH), also known as outcome

My community assessment project focused on adults with chronic renal disease who are receiving peritoneal dialysis under the care of the Davita Dialysis Clinic located in Dothan, Alabama. This modality of artificial kidney replacement minimizes the disruption of the user’s daily life by allowing them to remove waste products from their bodies on daily basis during their ordinary sleeping hours. According the Centers for Disease Control and Prevention, it was estimated that as many as 10% of adults or more than 20 million people in the United States may be suffering from chronic kidney disease and in 2011 alone, 113,136 of these individuals began treatment for their end stage renal disease ("National chronic kidney disease fact sheet,

Unnecessary services are provided far too often because there is little coordination across sites or among providers, yet care management, cross disciplinary care, and preventive care are often uncovered or poorly reimbursed. Notably, 45% of the U.S. population have chronic conditions requiring care management. Of this population, 60 million, or roughly half of those with chronic conditions, have multiple conditions. Current care delivery systems are not designed to support the care of these complex patients, which requires multiple providers and services.

Chronic kidney disease (CKD) is an irreversible condition that progresses causing kidney dysfunction and then to kidney failure. It is classified by a GFR of <60mL/min for longer than 3 months. There are five stages of CKD: Stage 1 has kidney damage but has a GFR ≥ 90. Stage 2 has mild damage and a GFR of 60-89. Stage 3 has moderate damage and a GFR of 30-59. Stage 4 has severe damage and a GFR of 15-29. Stage 5 is also known as end stage renal disease (ESRD), this is kidney failure with a GFR of ≤ 15 and theses patients are typically on dialysis or in need of an immediate transplant. The leading cause of CKD is diabetes. Hypertension is also a major cause. Since most DM patients have HTN,