External Factors In Health Care

This is an opportunity for hospitals to work more closely with skilled nursing facilities and other post-acute providers to improve care transitions, and experience fewer readmissions. The ACA impacted hospitals by holding back a one percent reimbursement rate. Hospitals will actually need to perform and deliver high-quality evidenced based care to recover the one percent withheld reimbursement rate while hospitals that exceed the benchmark, will received a higher reimbursement rate over the one percent. The Act is intended to help spur the trend of more integrated care throughout the continuum. The Affordable care act (ACA) of 2010 designed programs for improvements and innovation in the quality of hospital care by instituting the Medicare’s hospital readmission reduction program. Through this program, CMS reduces Medicare payment bt one percent for hospitals for hospitals that demonstrated high rate of avoidable readmissions for patients with a diagnosis of heart failure, heart attack

"To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value” (Jointcommission.org, 2015). These requirements are regimented in the National Patient Safety Goals and are enforced via surveys and internal inspections to ensure that healthcare institutions abide by the safety mechanisms put in place to facilitate the optimal patient outcomes and environments.

External and internal influences are relevant in health care. These influences continue to affect the total operations of a health care facility. I will summarize the insights I have gained into the external influences of the new health care reform policy and quality initiatives. The recent health care reform legislation was passed in the house and senate this year. The senior vice president, that I have interviewed, states that health care reform is an “unknown” for organizations. In addition, I will research the quality improvement initiatives and how these external influences include implications for organizations and health care administrators.

By 2001 it was brutally apparent that the U.S. Health Care system was in dire need of a reform in regards to quality and patient safety. Following two separate reports issued by The Institute of Medicine (IOM), To Err is Human (1999) and Crossing the Quality Chasm: A New Health Care System for the 21st Century(2001) the U.S. Congress requested the IOM review quality processes across multiple government funded health care programs. And understandably, “these reports described America’s healthcare system as a tangled, highly fragmented web that often wastes resources by duplicating efforts, leaving unaccountable gaps in coverage, and failing to build on the strengths of all health professionals” (Brown J., p. I – 15, 2013). Thus, the Committee on the Quality of Health Care in America released 6 aims to address key dimensions that require improvement in our health care system. These aims propose that our system needs to strive to be more Safe, Effective, Patient-Centered, Timely, Efficient, and Equitable (STEEEP). All of which were created to help overhaul our current health care system and, more importantly, narrow the quality chasm.

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,

Better quality health care will affect the life expectancy rate and the expenses. Patients expect doctors and hospitals to deliver the best possible care. The major issue with the quality of health care is “medical errors result from faulty systems… not individuals” (Hughes). In order to ensure patient safety and positive outcomes, hospitals have to assess for themselves the various different aspects they need to improve on. For example, hospitals could have a shortage ranging from staff, medication, or equipment. Through universal health care, “doctors… can focus on patient care”, which will aid in improving treatments for each individual (White). Along with this, there will be more government funding to improve hospitals as a means to help patients. Countries under universal health care coverage have a better quality of care, while the “United States [is ranked] last overall” (“Right to Health Care”). These benefits of medical treatments of universal health care are vital to American

Healthcare in the U.S is most expensive than any other developed country. The U.S spends far more on per capita as compared to any other developed. U.S scores low on many outcome measures, inefficiencies and wastes and quality measures as compared to other countries. The Patient Protection and Affordable Care Act is developed to strengthen these failures in the health care system. The U.S healthcare is transforming care from volume based reimbursements to value based payments. The healthcare law works around providing more patient centered care and better preventive care. One of the payment reforms with Obamacare is to penalize the hospitals with high readmission rates for the three conditions – Acute Myocardial Infarction, Heart Failures and Pneumonia.

Under the ACA there is a new method of payment called value-based purchasing (Yuh et al., 2015). Value-based purchasing focuses on aspects of quality care such as: patient safety, efficient care, and customer satisfaction. By providing quality care, physicians and hospitals are offered incentives that deter them from providing avoidable and pricey care (Yuh et al., 2015). Another way that the ACA is enhancing quality care is through the Readmissions Reduction Program. This program will decrease the reimbursements that the hospital will receive if there are a surplus of readmissions within a 30 day period. Overall, this will also improve quality of care by making sure that the patient is really ready for discharge when leaving the hospital and also strengthen efforts to reduce nosocomial infections (Aoughsten et al.,

When Medicare was first established, Medicare adopted the payment methods of Blue Cross Blue Shield which meant that the program was paid hospitals on the basis of their own costs and physicians were being reimbursed by the fees that they charged which caused hospitals and physicians to provide care without boundaries (Anderson et al., 2015). This method caused Medicare to dissipate the budget that was established for beneficiaries to utilize. Now, with the ACA being implemented, Medicare had done an overhaul of payment reimbursement. Medicare is now moving toward a volume to value payment initiative that links payment to patient outcomes, experience of care, while giving providers an incentive to limit spending

The ACA included reductions in Medicare payments to plans and providers and introduced delivery system reforms that aims to improve efficiency and quality of patient care and reduce costs including accountable care organizations (ACOs), medical homes, bundled payments, and value-based purchasing initiatives”(Cubanski & Neuman, 2016, p. 2).

While there has been large media coverage about the insurance impacts of the Affordable Care Act (ACA), there has been a smaller amount discussed of the law’s changes to provider reimbursement policy, reforms to the delivery system, and investments in programs to improve the quality of care and constrain long-run growth in health care costs. And yet, the elements included in the ACA directed at cost and quality is possible to affect the practice of care for nearly every provider across the country. Although cost containment policies and initiatives are largely applied through federal health programs which including Medicare and Medicaid; cost containment in these programs has important cost-saving spillover effects to private health care markets through changes in health care practices and pricing across sectors of care.

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.

Patients want and expect to receive high quality care. Nurses want to provide the best care possible to their patients and like everybody else; want a pleasing job environment. Hospitals, on the other hand, are expected to provide a safe environment to patients, have enough nursing staff and remain profitable (Keller, Dulle, Kwiecinski, Altimier & Owens, 2013). The ultimate goal is to improve quality of care and patient safety across the United States; therefore, all the different interests of these major stakeholders should be taken into

In today’s health care system, “quality” and “safety” are one in the same when it comes to patient care. As Florence Nightingale described our profession long ago, it takes work and vigilance to ensure we are doing the best we can to care for our patients. (Mitchell, 2008)

Issues related to a lack of patient safety have been going on for a lot of years now. Throughout the first decade of the 21st century, there has been a national emphasis on cultivating patient safety. Patient safety is a global issue, that touches countries at all levels of expansion and is one of the nation's most determined health care tests. According to the Institute of Medicine (1999), they have measured that as many as 48,000 to 88,000 people are dying in U.S. hospitals each year as the result of lapses in patient safety. Estimates of the size of the problem on this are scarce particularly in developing countries; it is likely that millions of patients worldwide could suffer disabling injuries or death every year due to unsafe medical care. Risk and safety have always been uninterruptedly been significant concerns in the hospital industry. Patient safety is a very much important part of our health care system and it really