Noncompliance: A Complex Ethical Issues Of Patient Compliance

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

The purpose of this assignment is to review the factual content of and critically reflect upon the legal compliance considerations of eight major areas including, the Joint Commission, HIPAA/HITECH, Health Finances, Revenue Cycles, Medicare Recovery Audit Contractors, OIG work plan, OIG Corporate Integrity Agreement (CIA), the False Claims Act, and compliance and Provider Self Disclosure Protocol. These key elements have been provided by the GRC software Compliance 360 webpage.

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,

D- The patient arrived on time for her session and reports being stable on dose and haven't used any illicit drugs. This writer advised the patient that this writer was in fact in receipt of missed phone call about coming to the session at 10:30 am rather than 10 am due to her mother in the process of selling the house. This writer addressed with the patient about letter from CHR from her counselor, Jade Bray stating about the patient non-compliance with her appointment due transportation barrier. According to the patient, she is going through hardship as her mother is no longer taking her to her appointment as the patient says, " She's tired of bringing me everyone, Charlene. She complains about bringing me here and does not understand why I can't even get a bottle...:Like c'mon. What do I have to do?" This writer explained to the patient about TEAM decision, at which the patient disagree with the decision. This writer asked the patient about her "judgement." According to the patient, she feels she is making judgement by not engaging any further altercation with patient at the clinic, dosing daily, coming to her counseling session, and trying to get help from Chrysalis for

Value-Based Payments (VBP) is a tactic utilized by purchasers to encourage quality and the value of health care services (Health Care Incentives, 2017). Value-Based Payments offer financial incentives to doctors, hospitals, medical groups, and health care providers (Webb, 2015). The incentive is to provide better care for their patients and to focus on the quality of the care they are providing rather than the number of people they treat. This payment model is being used as a way to keep DSRIP sustainable (NYSDOH, 2015). The VBP Model offers a roadmap, which outlines a five year plan to attaining inclusive payment reform; which includes a shift to 80% VBP through Medicaid managed care plans (The Commonwealth Fund, 2017). This payment reform should be accomplished by the end of DSRIP enactment period of five years (The Commonwealth Fund, 2017).

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.

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.

Value-based purchasing (VBP) outlined by Roussel et al. (2016) is a payment methodology that rewards quality of care through payment incentives and transparency. Some of the key elements comprise of:

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).

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.

One of the major goals of the ACA is to improve quality of care by using a value-based system. Nationwide, nearly 3,500 short-term acute-care hospitals are reimbursed under the Inpatient Prospective Payment System (IPPS). Within the IPPS is the Hospital Value-Based Purchasing Program is (VBP). This program “rewards acute care

Confidentiality is one of the main duties of health care providers. They are required to keep a patient’s health information private unless patient consent to release of the information (De Bord et al, 2013). Dilemmas in patient’s confidentiality may arise when there is disagreement between the principle of confidentiality and other ethical principles such as avoiding harm to the patient or others.

Since out based incomes are financial incentives, they generally foresee the generation of more amount of medical care per patient. Thus, if doctors are making money from unnecessary medical procedures, there is an ethical issue of physicians not wanting the best for their patients. Active informed consent (based on knowledge about procedure, risk, benefits, etc.) by the patient (or proxy) in response to a physician's prescription should only be of the best interest and well-being of the patient. Active informed consent is essential, but not enforced to the same degree by all medical professionals. As a physician, I will make every single effort to change this. I want to influence other physicians, nurses, and health professionals to always keep in mind the best interest and well-being of the patients. As stated previously, not every health care professional is like this. I am thankful for all the healthcare professionals who keep their patients’ wellness as top priority. However, there is still a precedent issue that I felt strongly to

Under payment, an ideal healthcare system will have the challenge of delivering higher quality for lower costs. The system’s payment reform will involve a transition from fee-for-service to global from systems that are value-based important for the achievement of the overall healthcare goals. An ideal healthcare payment system will give a great deal of support to value-driven system of healthcare delivery (Kent, 2013). The fee-for-service payment system will be of great importance to the healthcare system as it will help control the costs of health care.