Nursing Sensitive Value-Based Purchasing

The Hospital Consumer Assessment of Healthcare Providers (HCAHPS) began in 2006 with a 27 question survey that is distributed to discharged patients. This survey process was originally designed to help patients compare hospitals in their area to be able to make an informed choice for their healthcare needs. In January 2013, five additional questions were added to the survey. Beginning this year, Medicare reimbursement rates to a hospital are tied to the hospital’s patient satisfaction scores. Therefore, hospitals are continually looking for ways to improve

Healthcare is in a constant state of change with movements that impact rates, access and quality of care. Hospitals have become more competitive due to the rising cost of care delivery and the reduction in reimbursement from payers. This causes difficulty in delivering quality care to all patients, which is being measured by mandated patient perception surveys, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS scores are part of value

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

Mandatory nurse-patient ratios have been a controversial topic facing nurses for decades. Nurses, patients, physicians, nursing organizations, researchers, hospitals, federal government, and state governments have opposing views in regard to mandatory nurse-patient ratios. Those that support the idea of mandatory nurse-patient ratios believe that there would be an improvement in quality of patient care, decreased nursing shortages, increased job satisfaction, decreased client hospitalization, and increased nurse recruitment (Pamela Tevington, 2012). Groups that oppose mandatory nurse-patient ratios believe that mandatory staffing laws ignore factors such as the level of care a patient requires from a nurse, treatments, length of hospitalization, improvements and differences in technology, the expense of an increased nursing staff, and nurse experience and education (Tevington, 2012).

A powerful force for change can be created by embracing transparency. According to the Department of Health and Human Services, “transparency is a broad-scale initiative enabling consumers to compare quality and the price of health care services so they can make their own informative choices among doctors and hospitals. This initiative is laying the foundation for pooling and analyzing information about procedures, hospitals and physicians services. In order to create value driven health care, there are four steps to turn raw data into

Where there is transparency, there is good accountability thereby reducing government deficit. “Its past time to require transparency of cost and outcomes, so consumers can make informed choices about their care. As patient – consumers increasingly transition to high-deductible plans and other models that increase their cost exposure, they will demand more transparency and information for the choices they need to make. However, simply having some awareness that not every hospital is performing equally well and consumers should be making informed choices is an important first step towards a true market-based healthcare system”(Rita Numerof

The goal of the LeadingAge Texas is to implement higher direct staffing hours for each resident allowing for positive outcomes, which is what the government was trying to accomplish through Texas Quality Incentive Payment Program (QIPP). QIPP implemented the goals of decreased pressure ulcers, decreased usage of antipsychotics, decrease in falls, and physical restraints (Texas Quality Incentive Payment Program, 2016). While these incentives assist in improving quality care, quality care starts at adequate quality staffing. Staffing is the key to quality care and is what consumers advocate; however, the nursing industry would rather implement incentive programs (Harrington et al., 2016). As shown by the failure of QIPP and NHQRE, quality staffing is needed to improve the quality of care.

To deal with this information gap, the Hospital Quality Alliance program integrated the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey into its series of measurements. Several hospitals have

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).

Quality and financial viability being closely tied is an extremely salient point. Furthermore, the Affordable Care Act has influenced the requirement for high-quality, cost-effective care provision by implementing Value Based Purchasing (Aroh, Colella, Douglas, & Eddings, 2015). In addition, there are presently Centers for Medicare and Medicaid (CMS) quality indicators that effect reimbursement for hospitals (Xu, Burgess Jr, Cabral, Soria-Saucedo, & Kazis, 2015). For example, if a facility does not meet the indicator threshold for catheter associated urinary tract infections, central line infections and/or pressure ulcers their reimbursement is affected. Given that the quality of care provided by a hospital is

Value Based Purchasing refers to a strategy used by employers and the Federal government to provide excellence in health care. It entails improving healthcare quality in order to improve population health. The program is used by Medicare and what is included is measuring and reporting comparative performance, paying providers based on performance, and designing health benefit strategies and incentives to encourage individuals to provide higher quality care. Leaders should be concerned because although people are working hard to ensure everyone has access to good health care, the problem is keeping it affordable. Also, value-based purchasing is in its early stages, therefore there is lack of data. It is important for leaders to have evidence-based care in order to provide the best preventative care possible.

The introduction of value-based purchasing by the Centers for Medicare & Medicaid Services’ (CMS), implemented a program in which participating hospitals are paid based on the quality of care of the services the patient received (Hospital Value-Based Purchasing, 2015). Therefore, if hospitals want to recoup benefits from Medicare and Medicaid, excellent care and services must be provided.

Quality measures are strategies that gauge, evaluate or compute health care processes, results, discernments, patient insight, and administrative structure. In addition, quality measures are frameworks that are connected with the capacity to deliver first-class health care and/or that are able to identify with one or more quality objectives for medicinal services. These objectives include: compelling, protected, effective, quiet focused, impartial, and opportune consideration. Quality measures can be used to measure quality improvement, public reporting, and pay-for-reporting programs specific for health care providers (CMS.gov, 2016). There are an assortment of quality measures in which health care organizations can use to determine the status of the care they are delivering. Many are appropriate, but few are chosen for this research paper. Among them are: National Health Care Surveys, Hospital IQR Programs, Scorecards, and Political, Power, and Perception/Data for Decision-making tools.

A study published in 2014 by Olga Yakusheva a researcher from the University of Michigan stated the fact that with only a 10% increase in ratio of BSN prepared nurses there was 10.9% lower chance of patient mortality on hospital units. The same study stated that if the number of BSN care providers was increased to 80% it would have an effect that would significantly lower length of stay and rate of readmission. The cost of increasing BSN prepared nurses would be nullified by the expenses saved by lowering the hospital readmission rates and the average length of stay. (Yakusheva, Lindrooth, & Weiss, 2014).

I am definitely for value-based nursing. Value-based nursing puts the patient first. Although some people think it is all about the money, it is actually all about the patients! If nurses are giving high quality care as well as being cost effective by not wasting supplies, there will be more room in the budget for new supplies, and possibly more nurses. If nurses are frivolous with supplies and using things that are not needed, there will be less money in the budget. This benefits patients because they will not have to pay for unnecessary items, there will be better equipment on the unit to provide their care. Nursing care is one of the largest expenses in the health care system (Welton & Ellen, 2015). It is very