Examples Of Surgical Error Quality Improvement

In the United States alone there are 98,000 deaths per year caused by low quality health care (Ignatavicius & Workman, 2013, pg. 2). This statistic is disturbing because the errors that resulted in death were errors that were preventable. The intent of this chapter is to bring awareness to health care providers that are able to make a change in the quality of health care. In current practice patients are subjected to medication errors, preventable hospitalizations, premature death, and poor care provided due to racial, ethical, or low-income factors.

The change to value based purchasing has bought many challenges to the healthcare industry. With the change to value-based purchasing for payments, it has changed how healthcare organization receive payment and delivery care. The advantage of have value based purchasing is that it improves the quality of care while reducing cost in an effort of aligning patient’s with the right provider and treatment plan (Minemyer, Jun 29, 2016). However, there are many disadvantages, such as it increases the patient volume as counteracting the reduction of procedure volume (Brown, B. & Crapo, 2016). Also it makes providers more responsible for care that is beyond the expected treatment of care needed (Minemyer, Jun 29, 2016). With quality measures tied

This model reimburses hospitals based on quality of care instead of the volume of patients. The quality of care is assessed by patient questionnaires and if hospitals are unsatisfactory penalties may be imposed (Edwoldt, 2012). The value-based system also affects Medicare and Medicaid. It was reported that Medicare readmissions within 30 days of discharge cost 17 billion dollars annually (Edwoldt, 2012). Due to the high costs of readmissions Medicare and Medicaid have implemented a Hospital Readmission Reduction program. A formula is utilized to evaluate readmission rates within 30 days of discharge for any medical reason related to their original admission such as heart failure and pneumonia. Upon review the hospital is potentially penalized. It is important that nurses strive to provide excellence in care despite their beliefs on the ACA. Nurses have the ability to provide a safe patient environment and reduce the risk of hospital associated infections by following hospital protocols such as hand washing.

In 2013 an average of one out of eight Medicare patients are readmitted within a 30-day period which lead to the estimated costs of around $18 billion a year for Medicare patients alone. Hospitals will either be penalized or receive bonuses for their performance with readmissions. This program will encourage hospitals to concentrate on ways to improve coordinating transitions of care while improving the safety and quality of care provided. In order to

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.

In recent years, emphasis has been placed on improving the quality of health care services and the overall patient experience. Innovative measures are needed to meet these expectations, while also containing the rising costs of health care. The government has enacted new laws in attempts to provide incentives that base Medicare payments in part on quality. In fact, the Patient Protection and Affordable Care Act of 2010, requires the implementation of value-based purchasing (VBP), which bases Medicare reimbursement rates on the quality of care (Kennedy, Wetzel & Wright, 2013). Hospitals may experience a decrease in revenue initially, however, it is theorized that the increase of transparency and accountability will serve as an incentive for improvements in the overall quality of care provided in the United States.

This savings would be a direct result of decreased overpayment by Medicare to hospitals, physicians and insurance companies (Perez, 2013). As a result, Centers for Medicare and Medicaid is incentivizing increased quality care in hospitals. Consequently, hospitals are not getting reimbursed for hospital acquired conditions. In addition, CMS is penalizing hospitals for readmissions (Bauchner, 2015). Lawmakers are expecting resounding savings related to CMS expectations. The short term savings of more than $200 billion through 2016 (CMS, 2015). As a result, hospitals are in a paradigm shift from volume based care to value based care. The expectation is that hospitals will reduce waste and decrease inappropriate waste which will result in savings that be used for other therapies (Bauchner,

Healthcare costs in the United States (U.S.) have escalated exponentially in recent years due to many factors. The Affordable Care Act was legislation passed in 2010 to attempt to change the delivery of healthcare in the U.S. and circumvent the continued rising healthcare costs. A major factor contributing to healthcare costs is the Medicare population and their readmission rates to the hospital within 30 days of discharge. This factor involves many layers of services and financial implications. This paper will discuss how healthcare quality results in hospital readmission, the fines that are imposed by the government through Health Readmission Reduction Program, the changes implemented by hospitals to decrease readmission

The idea that the healthcare reimbursements should be linked to the quality outcomes and performance measures is central to the Patient Protection and Affordable Care Act. The legislation provides various reforms that either provide incentives to healthcare providers for better quality services and outcomes or reduce their payments if certain quality standards are unmet. This paper talks about the different reforms under PPACA, aimed at introducing payment variations based on quality of care such as, Hospital Value Based Purchasing (VBP) program, improvements to different quality reporting programs, payment adjustments for hospital acquired conditions (HAC), reduction of hospital readmission rates (HRRP), testing for

Helping patients stay out of hospitals is not only an important quality improvement objective but also a financial one especially after the advent of Affordable Care Act (ACA). Efforts to improve clinical outcomes and reduce readmissions have been ongoing for several years, but still high readmission rates continue to be an issue for most healthcare organizations. Although many hospital readmissions cannot and should not be avoided, a wide variation in readmission rates across the hospitals nationwide, has led the researchers and Center for Medicare and Medicaid Services (CMS) to believe that hospitals can implement various quality improvement strategies to reduce their readmission rates and improve patient care as a whole. In an effort to reduce readmission rates and achieve better quality outcomes, CMS has started Hospital Readmission Reduction Program (HRRP) under which the hospitals will be penalized by up to 3% of total Medicare reimbursements, for readmission cases within 30 days specifically for conditions like heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), and elective hip or knee replacement. The percentage of hospitals receiving a penalty in 2014 was around 64%, which has increased to about 78% in FY 2015 making it a high priority quality improvement concern for healthcare organizations in order to retain their Medicare patients and balance their Medicare reimbursements.

The reimbursement method I will be discussing is the Pay-For-Performance, which is this method that provides financial incentives to medical facilities and healthcare providers to make specific improvements and/or achieve outstanding outcomes for patients. For example physicians can receive bonuses for meeting set goals for the facility such as minimizing reoccurring preventable medical issues in certain population of patients. The CMS established 4 quality measures (process measures, outcomes measures, patient measures, and structure measures) to assess the performance of providers and medical facilities and also includes penalties for poor performance. One of the quality measures (patient measures) gives the “power” back to the consumer

There are many healthcare payment methods used when processing claims billed by a hospital or provider for services rendered to the patient. Those payment methods include, fee for service, bundled payment, value base pay, capitation and global budget. As stated previously in this discussion, HF is the most prevalent reason for an increase of readmissions rates ranging at 40% (Hobbs, 2016). Subsequently this problem affects how reimbursement is made payable to the hospital or providers. Currently, HF is greater among patients who are MCR beneficiaries and readmission rates for this population range from 22% to 25% (Banoff, 2016). With the substantial increase of readmissions, attracted attention from the Centers for Medicare and Medicaid

Promote quality of care using and developing clinical analysis of performance as it relates to risk adjustment and quality data. Influence present model processes and design/implement new programs to improve clinical

Some of the important reasons for selecting patient-centered, time, safe, quality of work, and patient satisfaction measurements of quality for the hospital mentioned above, are due to risk of adverse effects that are revealed in clinical settings, which leads to the limitations in standards of medical care for in-patent and emergency treatment (Stelfox & Straus, 2013). For example, the measurements of Safe is variable to the quality

In the early 2000s, serious deficiencies in quality health care had been highlighted by the Institute of Medicine (James, 2012). Recently, the use of financial incentives to reward for improving quality of care is a growing interest for many. Pay-for-performance programs provide bonuses to health care providers for meeting or exceeding quality measures. However, physicians in the United States have traditionally been paid for quantity versus quality of care (Blum, 2011). Utilizing incentive models, such as patient-centered medical home, pay-for-performance, and the fee-for-service payments are the most commonly used programs. Incentive programs may also reward on improvements that occur over time, such as year-to-year decreases in hospital readmission rates or decreasing hemoglobin A1c values in diabetic patients (Blum, 2011). Hospital can incur financial penalties under the Medicare guidelines for individuals who acquire certain preventable conditions during their hospital stay, such as urinary tract infections from use of catheters and pressure ulcers. However, there is insufficient evidence to support whether or not financial incentives improve quality of primary health care. In addition, it is unclear whether financial incentives could potentially cause harm as they only incentivize based on certain health indicators. Therefore, physicians may spend more time focusing on meeting those indicators while paying less attention to other important issues