Pay for Performance Paper

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,

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

Over the course of our countries history, the delivery of our health care system has tried to meet the needs of our growing and changing population. However, we somehow seem to fall short in delivering our goals of providing quality, affordable and accessible healthcare to our citizens. The history of our delivery system will show we continuously changed the delivery of our system however never mange to control cost. If we can come up with efficient ways to cut cost, the delivery of quality care will follow.

By 2001 it was brutally apparent that the U.S. Health Care system was in dire need of a reform in regards to quality and patient safety. Following two separate reports issued by The Institute of Medicine (IOM), To Err is Human (1999) and Crossing the Quality Chasm: A New Health Care System for the 21st Century(2001) the U.S. Congress requested the IOM review quality processes across multiple government funded health care programs. And understandably, “these reports described America’s healthcare system as a tangled, highly fragmented web that often wastes resources by duplicating efforts, leaving unaccountable gaps in coverage, and failing to build on the strengths of all health professionals” (Brown J., p. I – 15, 2013). Thus, the Committee on the Quality of Health Care in America released 6 aims to address key dimensions that require improvement in our health care system. These aims propose that our system needs to strive to be more Safe, Effective, Patient-Centered, Timely, Efficient, and Equitable (STEEEP). All of which were created to help overhaul our current health care system and, more importantly, narrow the quality chasm.

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,

Better quality health care will affect the life expectancy rate and the expenses. Patients expect doctors and hospitals to deliver the best possible care. The major issue with the quality of health care is “medical errors result from faulty systems… not individuals” (Hughes). In order to ensure patient safety and positive outcomes, hospitals have to assess for themselves the various different aspects they need to improve on. For example, hospitals could have a shortage ranging from staff, medication, or equipment. Through universal health care, “doctors… can focus on patient care”, which will aid in improving treatments for each individual (White). Along with this, there will be more government funding to improve hospitals as a means to help patients. Countries under universal health care coverage have a better quality of care, while the “United States [is ranked] last overall” (“Right to Health Care”). These benefits of medical treatments of universal health care are vital to American

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

The cost and quality of health care and access to it is one of the foremost aspirations in national health care. And the overall main aims of reforming the American health care system is to reduce costs, enhance the quality of and access to health care [1].

In healthcare system the highest quality medical care means” the greatest benefit to patients at the lowest possible cost” (Burke & Ryan, 2014, p. 3). “The Agency for Healthcare Research and Quality (AHRQ) defines quality health care as doing the right thing for the right patient, at the right time, in the right way to achieve the best possible results” (NCQA, p. 3) According to American college of physicians, the single most reason for the health care cost is higher healthcare spending. There are several factors involved in the high health care cost such as inappropriate use of technologies, lack of patient centered care, overuse of the reimbursement, excessive price for health care facilities, increased organizational cost, and health accountability are some of the reasons for increased health care cost. In order to decrease the cost, the available health resources be used judiciously and equitably. Understanding these factors and identifying the potential factors of health care costs assists in providing quality and effective services and thus improves the health outcomes (ACP, 2009).

Ransom, E. R., Joshi, M. S., Nash, D. B., & Ransom, S. B. (Eds.). (2008). The healthcare quality

However, prior to the existence of the ACA, the American healthcare system left a lot to be desired and still today leaves room for improvement. The basic issues underlying efforts to improve the United States (US) health care system remain, as they have for decades, concerns for costs, access, and quality (Sultz, 2006). Even though knowledge, technology, and

A challenge that the healthcare nation is facing is to provide the quality of care that is expected and obtain low healthcare cost. Working hand in hand with the private sector and government is in hopes of improving the quality of care that each patient deserves and maintaining the cost so that research can continue. The purpose of this paper is to look into relationships between healthcare cost and quality healthcare.

There is a growing trend in the United States called pay-for-performance. Pay-for-performance is a system that is used where providers are compensated by payers for meeting certain pre-established measures for quality and efficiency (What is Pay-for-Performance, n.a.). We are going to be discussing what pay-for-performance is. There are different aspects of pay-for-performance which include; the effects of reimbursement by this approach, the impact cost reductions has on quality and efficiency of health care, the affects to the providers and patients, and the effects on the future of health care.

Hospitals in the United States offer top quality care to its citizens but regrettably not everyone receives equal access to this care. There is an alarming difference between qualities of care received by some population groups relative to other population groups.

Quality is one of the most essential elements of healthcare. As stated by the Agency of Health Research and Quality, “Everyday, millions of Americans receive high-quality health care that helps to maintain or restore their health and ability to function” (Agency of Health Research and Quality, 2014). Improvements have become vital to the success of health care organizations and in the Healthcare Quality Book, it is explained that quality in the U.S. healthcare system is not at the standard that it should be (Ransom, Joshi, Nash & Ransom, 2008). Although this has been a reoccurring issue, attempts to fix the insufficiency have been less successful than expected.