Integrating Electronic Medical Records ( Emr ) With A Healthcare Management Information System

The three significant pay-for-performance (PFP) initiatives in the United States are the Leap Frog Group’s Hospital Rewards Program, Bridges to Excellence and the Medicare PFP initiatives. The leap frog website states, that their program is “an initiative driven by organizations that buy health care who are working to initiate breakthrough improvements in the safety, quality and affordability of healthcare for Americans”. The Leapfrog Group was founded by a small group of large employers in 1998.

The advantage of VBPS program is that it promotes and reimburses for all treatments that are planned to help to bring better health outcomes for Medicare patients. This program also plays a part in reducing the rate of unnecessary tests and referrals that are unrelated to treating of patients’ conditions. The program gives incentive rewards to healthcare facilities that are successful in reporting the high quality of cares and better patients’ health outcomes. It also serves as supports and guidelines for healthcare facilities to build needed infrastructures to improve their quality of services (Minemyer, 2016).

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

Not only did Medicare transition from a FFS reimbursement to PPS for financial concerns but to also make providers hold a higher quality of care. Provider reimbursement will only occur, or occur at a reduced rate, if the care provided met these quality standards. One of the main programs that Medicare developed to keep hospital at a quality standard is the Hospital Value-Based Purchasing (VBP) program. The VBP program is a pay-for-performance approach for reimbursement that assesses: “how well a hospital performs on

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.

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

This article provides background on previous financial models used such as fee-for-service and the potential costs between practitioners. The article states that in the fee-for-service model of payment many physician operate disjointed care and often rely on patient volume rather than need. It attempts to create a strategy to change physician behavior and incentivize them to work as a team focused on a set of guidelines for a specific episode of care. The article is largely important as to give background information on bundled payments that are already currently happening with the pilot programs brought forth for hospital related health care services. One program is the Medicare Acute Care Episode (ACE) Demonstration for Orthopedic and Cardiovascular

With new reforms being put in place under the Affordable Care Act such as the pay-for-performance (P4P) also known as “value-based purchasing,” which is intended to help provide maintain and efficient programs to improve health care cost. Healthcare providers, hospitals, medical groups, and physicians are offered incentives for meeting certain performance goals; it also fines for increased costs and medical errors such as incorrect medication or dosages. In two different studies quality of care was found to have improved at P4P hospitals compared to non-P4P hospitals Lindenauer et al. (2007) and Grossbart (2006). However, a study by Werner et al.(2011) found no continuing benefits in quality of care. One measure being advocated for is the Hospital Readmissions Reduction Program (HRRP) to prevent hospital readmissions as a way to improve the quality of care and at the same time cut cost. If patients are readmitted within 30 days after discharges due to conditions like acute myocardial infarction (AMI), heart failure, and pneumonia, fines can be levied such as 1 percent of Medicare payments. Others include the Hospital Value-Based Purchasing (VBP) is based on how well the hospital performs compared to other hospitals or the improvement of their own performance compared to a baseline time. The goal is to encourage better outcomes for patients and improve experience during hospital stays. And the Hospital-Acquired Condition (HAC) Reduction Program motivates hospitals to increase the safety of it patients by cut the number of hospital-acquired conditions and patient safety (Medicare.gov, n.d.) (Kruse, Polsky, Stuart, & Werner, 2012)(Gu et al.,

The predominant system of payment to healthcare service providers had been the fee-for-service system for years. This system rewarded the providers for the intensity of their work. However, greater volume of services was not necessarily associated with better service quality. This incentive structure had policy makers concerned and thus, came the pay-for-performance into being established to improve service quality. The use of this system has been expanded by the Patient Protection and Affordable Care Act (PPACA). Many studies were performed to identify ways to make the system more effective. However, the studies had somewhat mixed results.

These new models aim to transform traditional fee-for-service (FFS) payments that reward episodic care into models that reward the delivery of comprehensive primary care (Edwards et al., 2014). The Belvoir Primary Clinic will seek to take advantage of all potential reimbursement methods such as the Enhanced Fee-for-service (EFFS) model which will allow the clinic to receive augmented payments due to its PCMH status (Edwards et al., 2014). The practice can also qualify for additional payments by using PCMH specific codes to bill for non-visit related care such as care coordination and transition support (Edwards et al., 2014; Gray & Aronvich, 2016). Furthermore, the practice can also receive incentives through value-based and pay-for-performance (P4P) programs by meeting performance measures and utilization goals (Edwards et al., 2014).

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

Change can be devastating and not always everyone agree with it. The biggest transformation in healthcare is the implementation of the Affordable Care Act. With the new health care system the government mandated U.S. citizens and legal residents to have health insurance that resulted in the rise of insured individuals. Due to the new policy more people have access to health care that means more primary physician needed to accommodate the rise of new patients. Shortages of physicians not only in the primary care area but also in specialty care area are projected between 46,000-90,000 by 2025 ("The Physician Shortage," n.d.). The pay-for-performance focuses on quality that will eventually decrease the costs (James, 2012, p. 1). This system will give a reward or a bonus to the health care providers whenever they meet or exceed quality standard that are being set (James, 2012, p. 1). In contrary the system can also penalized those providers that are unsuccessful in providing the indicated goals or cost savings (James, 2012, p. 1-2). There are 2,225 hospitals in 2013 that were fined under the Hospital Readmissions Reduction Program (HRRP) which is part of the ACA regulation (Anderson, 2014, p. 11). For the institutions to survive with the new system a lot of hospitals are merging that a year after the ACA implementation there

My first week at ACS was very exciting. I met a lot people and was introduced into the new changes pertaining to the quality payment program (QPP) that came into effect this year. I learned that the physicians’ quality reporting system (PQRS) along with the EHR incentive and value modifiers are being consolidated under Merit-based Incentive Payment System (MIPS). The Medicare & CHIP Reauthorization Act of 2015 (MACRA) created two tracks, MIPS and Advanced Alternative Payment Models (APMs). The goal of MACRA is to improve overall quality of care, reduce medical errors, eliminate redundancy, and improvement of health. Health care entities have the option to comply with one or the other. These entities include physicians, nurse practitioners,

For example, Medicare established programs that link quality of service to payment amounts. One program is called the Hospital Readmissions Reduction program (Medicare.gov, n.d.). This programs seeks to reduce readmission rates in hospitals (Tepper & Wojciechowski, 2013). Hospitals that experience high rates of readmissions and that participate in CMS’s Inpatient Payment System (IPPS) are subject to a reduction in payment from CMS (Medicare.gov, n.d.). This type of pay for performance creates unintended

Another reimbursement is the Pay-for-performance model where the providers are only paid when they are able to achieve a specific goal. “Insurers pay providers an “extra” amount if certain standards, usually related to the quality of care, are met”(Gapenski, 2013, p.69) The