Essay On Bundle Payment

Healthcare has evolved over past decades and continues to remain an issue of concern for individuals everywhere. Effectively managing data is important to improving the performance in the health care system. Accumulating, evaluating, deciphering and acting on data for particular performance measures allow health professionals to identify shortcomings and make the necessary adjustment, and track the outcome.

In this discussion board post, I will compare and contrast informatics and clinical informatics. Then I will give two examples of clinical informatics found in my organization that has been found to improve patient care. I will also give two examples of how my nurse manager can utilize data management in order to improve patient care. Lastly, I will discuss why President Bush mandated that all health records be in electronic form by the year 2014.

The ACA programs are a fee-for-service reimbursement into expenditures for comprehensive bundles of care that authorizes the National Pilot Program on payment bundling in Medicare, which will increase efficiency in the delivery of care and consequently

Accountable Care Organizations – “ ‘National Pilot Program On Payment Bundling’ - The Secretary shall establish a pilot program for integrated care during an episode of care provided to an applicable beneficiary around a hospitalization in order to improve the coordination, quality, and efficiency of health

Background: The Federal Agency for Healthcare Research and Quality (AHRQ) identified five goals for adopting health information technology (HIT) into the current health care systems that would significantly improve healthcare in America. (Abdelhak, Grostick, & Hanken, 2012, p. 82) These goals will help improve the quality of care within the federal health system by reducing medical errors, cost, and duplication of workload.

Health care in the United States (U.S.) is driven by a makeshift of services and financing. Americans access health care services in diverse ways, from private doctors’ offices, to hospitals, and to insurance providers. The effects of the ACA will have numerous changes impacting hospitals and physicians practices. One of the main goals of healthcare reform is to reduce Medicare expenses by combining payment for services provided by hospitals, doctors, and nursing homes into one lump sum, which will effect

The aim of this paper is to provide a brief description of the bundle payment initiative will be addressed in relationship to the Affordable Care Act (ACA). Additional focuses will be placed on comparisons of the bundle strategy with traditional Medicare fee-for-service (FFS) payments. The purpose of the analysis is to implement and design a bundle payment program for community acquired pneumonia (CAP) patients utilizing the bundle program. The analysis will address health care providers and service vendors needed to successfully implement the program. Additionally, AONE nurse executive competencies will be discussed in relation to skills needed by nurse leaders in collaboration with the programs implementation.

This report will analyze delivery and payment (financial) models in existence today after the implementation of the ACA. The purpose of this report is to provide information on at least 5 payment models and different types of models that are implemented in the healthcare organizations with our choice of health care industry

The Patient Protection and Affordable Care Act, often referred to as the Affordable Care Act (ACA), was signed into federal statute on March 23, 2010 by President Barack Obama. Since the implementation of Medicare in 1966, this is the largest healthcare reform to be passed. With the ACA came an overhaul of the existing health care system and its reimbursement systems. Most notably, Medicare reimbursements are now partially determined by patient satisfaction and experience. Among hospital administration and healthcare providers, this has been highly debated.

The proposal for bundled payments (CCJR) will force hospitals and other health care facilities to change and adapt. The proposal would include medical severity diagnostic-related groups which would help calculate targeted prices for each severity group and each hospital separately. Several controversial components would be included in the proposal. Mandatory participation is one of the key requirements to the proposal. Another controversial component to the CCJR program is that hospitals would be exclusively responsible for the bundled payment program and any financial excess. However, these controversial components are key features to ensuring the proposal’s success which will help patients and providers in the future. Another reason the CCJR proposal will force hospitals to adapt is that the hospitals would be financially accountable for the quality of care. If the hospitals fail to meet three specifically designed protocols for quality, the hospital(s) would be ineligible for savings

In comparison to the fee-for-service reimbursement model, bundled payments support, and pay care coordination, while reducing cost among a patient’s provider. A bundled payment compensates all of a patient’s health care suppliers with a sole, fixed, all-inclusive payment that shields suggested clinical services associated to the patient’s treatment, episode, or illness over a well-defined period of time (Association, 2013). These disbursements can be modified and constructed based on the patient’s health status.

Bundled payments reimburse multiple health care providers with a lump sum that reflects the expected costs for a predefined episode of care and post-acute care services . For instance, if a patient goes into surgery typically the payers would reimburse the surgeon, anesthesiologist, and hospital separately for the services provided . With a bundled payment model all providers would receive a set amount for the episode of care based off of previous cost . “If the costs of an episode of care are less than the bundled payment amount, the providers (hospital and physicians) can keep the difference; if the costs of care exceed the bundled payment, the providers bear the financial liability” . The bundle payment model is viewed as a mechanism to

In health care, patients’ lives are in the hands of the health care practitioners, health care organizations, insurance companies, and to some degree, even health care technology. The growth and future implications of evidence-based medicine (EBM) through improvement of technology in health care are important today, because health care practitioners and organizations want to ultimately decrease cost, improve quality of care, and increase access to health care (Glandon, Smaltz, & Slovensky, 2014, p. 28). One way to achieve these goals is through the implementation and improvement of EBM and interoperability which will enhance the efficiency of work production resulting in these positive outcomes. According to Glandon, Smaltz, and Slovensky (2014), EBM is an “information management and learning strategy that seeks to integrate clinical expertise with the best evidence available to make effective clinical decisions that will ultimately improve patient care,” (p. 6). “Interoperability is the ability of different information and communications technology systems and software applications to communicate, to exchange data accurately, effectively, and consistently, and to use information that has been exchanged,” (Iroju, Soriyan, Gambo, & Olaleke, 2013, para. 1). Without interoperability and EBM, fundamental data and information such as patient records cannot be easily shared across and within enterprises having a direct impact on the quality of care. It

Our health care needs an increase in volume, sophistication, and variety; therefore, we need to improve our care provisions in order to keep pace with this growing burden. Biomedical Informatics research helps us to provide a given care in a better and cheaper way, and at the same time, it

Having a single view of the patient and their treatment and recovery plan is invaluable in ascertaining which are the most and least effective tactics in treatment. The 360-degree view of the patient and the many processes supporting them is crucial for increasing the accuracy, effectiveness and performance of treatment programs over time (Blakeman, 1985). Computerized management systems are critical for organizing, analyzing and translating the massive amount of data captured on patients, treatment and recovery processes, and the use of supporting IT systems to optimize patient health and organizational provider performance (Peshek, Cubera, Gleespen, 2010). The ability to aggregate and intelligently use all available data, information, patient-based and process-generated data to deliver higher levels of quality care is possible when computerized management systems are used throughout healthcare organizations.