Medicare Value Based Purchasing

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

Moreover, we see that some providers are focusing on what providers do and how they get reimbursed rather than what the patient needs, which is a focus that does not prioritize quality of care and therefore does not align with the Triple Aim framework. The problem presented regarding this matter is that the health care system lacks a patient-focused care of medical conditions that puts patients and their health needs first. For example, when we think of provider reimbursement, it is not in the patient’s best interest for the system to only have a simple fee-for-service structure. A structure like this one will only lead to an increase of health care expenses. Also, it fails to incentivize high-value service, which also does not align with the Triple Aim framework health care providers should go by. It is very crucial for the health care system in the United Stated to find a better balance between medical groups reimbursement and patients needs in order to reduce the risk of overutilization.

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

In the past several years, there have been several changes in economic policy at federal and state levels. The two economic policies that present to be the most precedent for healthcare leaders with concern to facility reimbursement are the Affordable Care Act (ACA) and the switch from volume to value reimbursement. First, there is the ACA policy, which have affected healthcare facilities and their reimbursement methods. In fact, ever since this policy was implemented, provider reimbursement has started to decrease in terms of fee-for-service payments (The Common-Wealth Fund, 2015). In other words, the intention of this policy was to provide budget relief to the government payers as well as giving providers an incentive to provider patients with great quality of care.

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

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.

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 service-based pay structure provides significant motivation for healthcare providers to deliver as many services as possible, with little to no consideration of patient outcomes. Furthermore, this structure provides no incentive for certain key elements of healthcare such as patient education and care coordination, both of which have led to diminished costs and better outcomes for patients. I am of the opinion that very little quality improvement will take place if this pay-for-service model persists. The current transition from service-based pay to quality-based pay is definitely a move in the right

The triad of cost, quality, and access has impacted the development of the Affordable Care Act on many levels. The Affordable Care Act aims to improve the quality of healthcare, while maintaining the cost of health care ("Quality of care," n.d.). Under the Affordable Care Act, there is more funding for each state to assist in treating people with chronic illness. The goal is for these patient populations to have high-quality services at an affordable cost (“Quality of care,” n.d.). To ensure that quality of care is provided, the Affordable Care Act requires quality measures to be met in order for organizations to receive reimbursement. Although the United States still needs improvement in providing high quality health care that is accessible

Besides, the financial incentives for hospitals and physicians that belong to ACOs, Jaffery & Golden 2013, asked and then answered the question “why would providers join this program? One reason is to prepare for the future”. Fee-for-service reimbursement, which has been how hospitals get paid for their services rely solely on the volume of patient seen without taking into consideration the quality of care provided. Payers today, such as government, commercial insurers, employers, and individual consumers are now requesting on value -based-payment, which consist of delivering the highest level of care at a lower cost. The volume based system even though the traditional way of how payments are made is not a viable long-term option (Jaffery and Golden, 2013, p.98).

However, the quality of these services seems to need improvements as better services to patients and proper care for health will impact the revenue cycle and reimbursements. Obama-care supporters are making the false impression that new government rules would promote opposition, control costs, and advance the quality of health care delivered within Medicare. Believing that, implementing this method would concurrently regulate the growth of Medicare costs in a more rational fashion and close the gap of health care we currently have and the health we would have in our future. No matter what department is seeking insurance reimbursement, accurate documentation is required along with proper billing codes to receive timely reimbursement.

Medicare has changed the way it pays hospitals for services delivered to clients with Medicare. Instead of only paying for the amount of services the hospital offers, Medicare also pays hospitals for providing top quality health care services. The Centers for Medicare and Medicaid Services (CMS), a federal agency that runs the Medicare program, is altering the way Medicare compensates for hospital care by giving rewards to those hospitals that delivers higher quality and higher value service to clients (Medicare.gov, n.d.). At the beginning of October 1, 2012, the Affordable Care Act (ACA) permits Medicare by reducing payments to acute care hospitals with surplus readmissions that are paid under CMS 's inpatient potential payment system (Medicare.gov, n.d.). Medicare has information regarding how the hospital 's quality care affects the disbursements it receives from Medicare. The Hospital Value-Based Purchasing (VBP) Program, created by the ACA,

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.