Payment System In The Healthcare System

In healthcare, throughput refers to the ED process that impacts patient flow (Jarousse 2011). Process and flow began to be scrutinized for opportunities to improve the overcrowding by becoming more efficient. Due to this new process focus, throughput was born. This is also the point where lean flow or lean thinking became prevalent into healthcare from a manufacturing stand point to improve throughput. Lean principles revolve around removing non value added steps and standardizing work flow and processes. When applied aggressively hospital wide, lean principles can have a dramatic effect on productivity, cost, and quality. Numerous books concerning lean healthcare have been published in recent years (Crane & Noon 2011).

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.

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,

Now a statute, the physician/hospital pay for quality, not quantity, public law number: 114-10 signed April 16, 2015 also referenced as H.R.2 —1st Session of 114th Congress (2015-2016), sometimes called the “Permanent Doc Fix” 04/14/2015 : Passed Senate; 03/26/2015 : Passed House (Medicare Access and CHIP Reauthorization Act of 2015, 2015), which defines the payment and reimbursement reform to doctors treating patients with Medicare. This extensive reform includes the CHIP program insuring children and those families that don’t qualify for Medicare but are unable to afford private insurance and is funded by the federal government and individual states.

It wasn’t just a couple of patients waiting for their appointments it was more than 50 people waiting to see the doctor. When it came time for my father to see the doctors they just did a quick look and in less than ten minutes we were done seeing the doctor. I was surprised because he didn’t even give us a chance to ask any questions and the most astonishing thing to me was that we waited a long time to see the physician and for him to tell us he will see us next week. This clearly shows to me that our healthcare system is market based because he clearly didn’t take the time to see my father. Another case that had happened for my father was that in order for my father to receive surgery he had to wait 6 months until the next available operating table, were it took him 2 years to receive both surgeries in his eyes. This hasn’t stopped and is continuing since my father has been receiving medical care I believe that my father has probably seen the doctors more than 150 days each year for the past 4 years that he has been receiving care. Our Healthcare System needs to change from market based to salary based for all the physicians because this will stop the overspending and the doctors will focus on the patients quality care rather than seeing the patients as money and making unnecessary procedures and test on the

Lean culture is the “combination of defining customer value, aligning around a common purpose, striving for perfection while at the same time respecting and developing employees” (O'Rourke, 2017). A Lean culture is an important component of a lean program. It serves as the framework in which lean tools and techniques are utilized. Without a receptive culture, the lean principles will fail. Leaders must champion a lean environment aligned with the mission, vision and values of the healthcare organization. In addition, leaders are tasked with creating an organization culture that is receptive to lean thinking (Going Lean in Health Care, 2005).

[20] cited (Miller, D., et. al., 2005).”“Adoption of Lean management strategies while not a simple task can help healthcare organizations improve processes and outcomes, reduce cost, and increase satisfaction among patients, providers and staff” . Balle [5] states that: “the adoption of lean in healthcare is very young it started in the late 90s but started to gain a little bit of momentum in the last decade and now in this decade many health organisations are looking at lean principles since it has been proven to be very successful in many cases around the world”.

The advantage of VBPS program is that it promotes and reimburses for all treatments that are planned to help to bring better health outcomes for Medicare patients. This program also plays a part in reducing the rate of unnecessary tests and referrals that are unrelated to treating of patients’ conditions. The program gives incentive rewards to healthcare facilities that are successful in reporting the high quality of cares and better patients’ health outcomes. It also serves as supports and guidelines for healthcare facilities to build needed infrastructures to improve their quality of services (Minemyer, 2016).

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.

They will now receive payments from the quality of care they provide to their patients. Those with higher based value will receive higher payments than their counterparts (Berenson 2010). I think this is very important because the healthcare system has been volume driven for so long that quality healthcare has been an issue for quite some time. In addition to value, this would definitely improve quality and efficiency needed for better patient outcomes.

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

The delivery system reform include: Mandates that the Secretary of Health and Human Services adopt value-based purchasing and payment methods for Medicare reimbursements for both physicians and hospitals. Creates incentives to reduce preventable hospital admissions. Creates a new Center for Medicare and Medicaid Innovation that will research, develop, test, and expand innovative payment and delivery arrangements. Encourages the formation of Accountable Care Organizations (ACOs) that allow hospitals and doctors to work together to manage and coordinate care and provides that these ACOs will receive a share of the savings they achieve for Medicare

Hospital reimbursement: Outline the significant components that make up the CMS IPPS (inpatient prospective payment system).

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.

Impact of lean practices on operations performance and business performance: Some evidence from Indonesian manufacturing