Healthcare Rating Essay

I am currently studying HNC Health Care and as part of my course I have to complete a graded unit, this will entail three stages; Planning, development and evaluation. This will be carried out while on placement within a hospital setting, within the planning stage I have to choose a patient and assist them with a nursing activity. I have chosen to follow Roper Logan and Tierney twelve activities of daily living the reason for this is that I find it to be the nursing model that is most effective as each activity has its own importance to the survival of life; also it follows the objectives of my graded unit. I have chosen the AL of eating and drinking as the patient I have chosen has severe Rheumatoid arthritis and has lost the use of her

Mandatory outcomes reporting, such as core measures for Acute Myocardial Infarction (AMI) and Congestive Heart Failure (CHF) have also changed the way consumers select what provider they will choose, in addition to these quality indicators being part of the pay for performance initiative

Over the course of our countries history, the delivery of our health care system has tried to meet the needs of our growing and changing population. However, we somehow seem to fall short in delivering our goals of providing quality, affordable and accessible healthcare to our citizens. The history of our delivery system will show we continuously changed the delivery of our system however never mange to control cost. If we can come up with efficient ways to cut cost, the delivery of quality care will follow.

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,

emerge as a professional entity until the beginning of the 20th century, with the progress in biomedical science. Since then, the

Healthcare providers that elect to participate in and receive reimbursement from Medicare must be licensed through their state, as well as, obtain and maintain certification for compliance with the Center for Medicare and Medicaid Services (CMS) Conditions of Participation (COPs). CMS is an agency within the Department of Health and Human Services that drafted guidelines for healthcare providers to meet acceptable minimum standards to operate and be reimbursed for services. Once providers are able to meet the COPs, they become a Medicare-Certified Agency and are granted a provider number. Each state is responsible for the certification of healthcare providers and a state survey is conducted every three years and as needed to determine if the healthcare provider continues to meet the minimum standards set in the COPs.

Medicare and Medicaid information can be overwhelming and confusing to both the consumer and the healthcare professional. The information highway known as the World Wide Web (WWW) can provide the answers to questions about these government benefits, but getting clear, informative and accurate knowledge can be overwhelming. O’Sullivan (2011) identified the WWW as “a primary repository for health information for the medically naïve yet technically savvy healthcare consumer.” One internet website that provides information about Medicare and Medicaid is CMS.gov ("Cms.gov centers for”). The Centers for Medicare & Medicaid Services (CMS) is the United States agency that administers Medicare,

However, prior to the existence of the ACA, the American healthcare system left a lot to be desired and still today leaves room for improvement. The basic issues underlying efforts to improve the United States (US) health care system remain, as they have for decades, concerns for costs, access, and quality (Sultz, 2006). Even though knowledge, technology, and

In today’s seemingly ever-changing world of healthcare regulation, medical professionals are burdened with many compliance requirements. On October 14, 2016, the Department of Health and Human Services released its final rule implementing the Quality Payment Program as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Starting January 1, 2017, clinicians who are reimbursed by the Centers for Medicare and Medicaid Services(CMS) are required to participate in the Quality Payment Program (QPP). (Centers for Medicare & Medicaid Services, 2016) The QPP replaced the Sustainable Growth Rate formula with the new payment structure in which clinicians are rewarded for delivering high quality care. There are now two pathways for

The delivery system reform include: Mandates that the Secretary of Health and Human Services adopt value-based purchasing and payment methods for Medicare reimbursements for both physicians and hospitals. Creates incentives to reduce preventable hospital admissions. Creates a new Center for Medicare and Medicaid Innovation that will research, develop, test, and expand innovative payment and delivery arrangements. Encourages the formation of Accountable Care Organizations (ACOs) that allow hospitals and doctors to work together to manage and coordinate care and provides that these ACOs will receive a share of the savings they achieve for Medicare

The Centers for Medicare and Medicaid Services support quality initiatives. The mission of CMS is quality health care for people with Medicare which is a high priority for the president. CMS began to start quality initiatives back in 2001 to assure quality care for all Americans through accountability. There are various quality initiatives that focus on every aspect of the health care system. From focusing on reporting quality measures for nursing homes to kidney dialysis facilities. Consumers can use the information provided on their website for these health care settings to assist them in making the right choices for the care provided.

Westmount Nursing Inc. is a for profit chain with seven different nursing homes. It has a grown from a small few bed facility to a facility with 4 different divisions that made to help make seniors more independent. The Westmount Nursing Homes were in search for a chief executive officer and president, which was filled by Shirley Carpenter. After Shirley Carpenter came on to the company, many changes were made and implemented. Some implementations were successfully, but she was also challenged with many problems with the Union Federation of Nurses and the Board of directors regarding wages and total quality management implementation. My recommendation would be for Shirley to stop the implementation of total quality management and focus on

The future and direction of health care has been the topic of discussion amongst politician and U.S citizens today. There are several challenges surrounding the future and strategic direction in which health care should be heading. Accreditation, quality of health care and organization’s compliance; access to health care, maintaining a skilled workforce, information technology and pay for performance are some of the challenges that currently presenting itself in healthcare today. If health care is not dealt with appropriately it will have a significant effect an impact on the strategic direction in the future and direction of care.

The Centers for Medicare and Medicaid Services (CMS) have recently begun requiring hospitals to report to the public how they are doing on patient care. Brown, Donaldson and Storer Brown (2008) introduce and explain how facilities can use quartile dashboards to

The positive outcomes that have resulted due to value base programs have caused the model to gain traction and ignite one of the largest changes in history in the health care marketplace. By linking reimbursements to service quality, insurers such as the Centers for Medicare and Medicaid Services have facilitated a massive leap forward in the performance of United States health care providers. This achievement is a considerable accomplishment in the face of an institution that has received reimbursement from insurers via a fee-for-service model during the last 75 years. Soon, valued based payment models will represent the norm as more insurers support initiatives such as shared savings program, integrated clinical care, and accountable care payment models.