My Future Practice

The policy issue that I have selected to discuss herein is the pay-for-performance payment model. I feel that this impacts a large number of our population and changes in this regard should be made. This type of payment model aims to use reimbursement to incentivize providers to deliver high quality services. Pay-for-performance model steps away from the traditional manner of reimbursement of fee-for-service, in which providers receive payment on the basis of frequency or volume of the services they provide regardless of outcomes. In contrast,

First implemented in 1985 by Aetna (previously U.S. Healthcare), P4P programs were used to reward top performers and improve outcomes (Bruno, 2012). The incentives were meant to improve the quality of patient care by basing incentives on patient outcomes. Conversely, fee-for-service reimbursements are based on the treatments and set limits on the amount reimbursed for services. Because of these limits, incentives for use of pharmaceuticals and non-invasive procedures can impact how physicians practice.

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,

Healthcare is often driven by consumers and insurance companies; there is strong pushes for insurance companies to start paying better through Patient Care Medical Homes (PCMH) or Accountable Care Organizations (ACO) rather than paying at a per-visit basis (Hamlin, 2015). With PCMH or ACOs payment is made on a continuum of care, encouraging the provider to be involved in all aspects affecting health of the patient (Derksen, & Whelan,

In addition, to the Disparities Standing Committee, implement proposals for incentivizing preventive care and primary care. Giving a patient a goal with a reward attached may sound silly but in hindsight, it actually motivates the individual to stay healthy which decreases visits to the hospital. More importantly, rearranging shared plans to fit a more aggressive design in which includes lower fees. However, it is imperative that organizations stress the collaboration between clinical and non-clinical entities. “Conduct demonstration projects to test payment and delivery system reform interventions to reduce disparities. Commitment to social justice is essential to achieve health equity, but insufficient without a strong business case that makes interventions financially feasible” (Chin, 2016).

Pay-for-performance programs are expected to expand across the United States health care in the near future, especially with the implementation of the Affordable Care Act. The pay-for-performance is going to continue to increase the quality of health care that the patient receives from their

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

These objectives reflect a shift away from the traditional provider centered medical model, in which patients are often treated as passive recipients of care, and toward a more patient centered service model in which health decision making is expected to involve the active participation of the patient or consumer. In keeping with the Healthy People 2020 objectives and incorporating the Institute of Medicine’s goals for evidence-based care which emphasize patient centered care and respecting patients’ individual preferences (Institute of Medicine, 2001), the Health Outcomes Research Program at St. Luke’s Mid-American Heart Institute has developed a database with which patient-specific data can be used to estimate and model individual patient outcomes during clinical care. Decision aids created from these predictive risk estimates can

In 2004, the Healthcare Effectiveness Data and Information Set (HEDIS) stated that “Kaiser Permanente Southern California (KPSC) region, where approximately 6,000 physicians in the Southern California Permanente Medical Group, and where approximately of 3.5 million adults and pediatric are treated, there performance was below the national 50th percentile”. (Kanter et al., 2013) Since the performance was below what they aspired to achieve, in 2005 KPSC recognized the potential to improve quality of care through providing complete care for patients who have chronic illness.

These mandates also require that some establishments provide customers with a good outcome and experience while at their facilities. There are also incentives provided to doctors who correctly diagnose their patients for the very first time reducing the rates of readmission this also applied to those that provided outstanding follow up care for patients “The new law provides incentives for physicians to join together to form “Accountable Care Organizations.” These groups allow doctors to better coordinate patient care and improve the quality, help prevent disease and illness and reduce unnecessary hospital admissions. If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save. Effective January 1, 2012” ( HHS>GOV).

For anyone who has kept up with the news, the US healthcare system has undergone major changes in recent years. Insurance providers are no longer able to deny someone coverage based on pre-existing conditions. The advent of healthcare marketplaces has changed the way people purchase health insurance. Children can stay on their parents' health insurance plans until 26. Leading the healthcare revolution is InnovaCare Health. This organization is a leading provider of Medicaid and Medicare Advantage plans. InnovaCare Health recently announced it would partner with the Health Care Payment Learning and Action Network. This is a significant private-public partnership that seeks to change compensation models to reflect the quality of care instead of quantity. This new partnership reflects InnovaCare Health's to affect change in compensation sooner rather than later. The current healthcare model focuses on reimbursing physicians based on the number of patients seen or procedures performed. This encourages "treadmill medicine," or a model that focuses on rapid turnover. This can often lead to detrimental effects on patient health. The new quality model would reward physicians based on practice targets. Potential goals include HbA1c goals for patients with diabetes, the percentage of patients who smoke, and hospital stay after surgical procedures.

If you asked most people to describe what they consider to be the main thing affecting our countries health they would probably describe something that falls under the category of medical care when in reality this makes up only 25 percent of what determines a population’s health (Where Health Begins).The rest of the influences that effect the health of a population come in the form of a person’s genetics, behaviors, socio-economic status, physical environment, access to healthcare, and even the policies and laws put in place around them. Many of these factors are not under the control of the individuals which is why it is important for us as future physicians to understand the barriers that face the people we will be serving in order for us

The effectiveness of the health care we provide at Salina Family Health Care is measured routinely. For example, there is a “health care plan” that encompasses 16 different aspects of health care that we’ve determined to be important to our patient population. For these 16 “goals” we have 34 specific interventions we’ve implemented to help us achieve these goals. We receive a monthly report of our progress toward meeting these goals which might include getting blood pressure readings below 140/90, catching women up who need a pap smear or encouraging smoking cessation in persons who smoke. This health care plan drives our practice and the feedback we receive for our efforts guide our practice daily.

The current health care sector is too costly and too fragmented with a lot of variation in care even with established evidence based guidelines. Providers lack the tools, support and information they need to offer the coordinated health management that can reduce cost and improve outcomes. Primary Care Physicians are constrained in their abilities to perform any proactive care that involves avoiding Hospital or ER visits, and influencing healthy lifestyles.

"The judge has made his decision, the accused has been found guilty." These are the words that one day I will finally hear. My future goal is to be a lawyer. A lawyer is a professional person authorized to practice law. They defend or prosecute people for the crimes they have committed. (dictionary.com) I am very out spoken and believe in fighting for what I want or think is right.