Shoemaker's Article Summary

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

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

Value-Based Purchasing which is part of the Centers for Medicare & Medicaid Services; the program allows healthcare providers to get incentive payments for quality of care they provide to Medicare beneficiaries; for doctors it could mean doing less mean decrease in revenue and lower salary for the doctors. Therefore, value-based care has its pros and cons based who you talk to.

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,

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

David Shoemaker provides two theories of egoism in the text--psychological theory and ethical theory. Psychological egoism is the claim that all actions are done solely for the sake of one’s own self-interest. Ethical egoism simply states that all actions ought to be done for the sake of one’s own self interests. Shoemaker elaborates stating ethical egoism is the more attractive theory.

Since the late 1980s, Medicare has reimbursed physician services using the Medicare Physician Fee Schedule (MPFS), which encompasses 10,000 procedure codes. Each code is assigned resource-based relative value units (RVUs), which are designed to reflect physician work, practice expense, and malpractice expense. To adjust for local differences in cost of living, each RVU is modified using geographic practice cost indexes (GPCIs) and then converted to dollars using a “conversion factor.” This system rewards physicians who produce a high volume of services; not surprisingly, Medicare Part B expenditures have grown rapidly.

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

The Improving Medicare Post-Acute Care Transformation Act (IMPACT) standardizes data collection and data sharing among post-acute providers. The IMPACT Act is part of the Centers for Medicare and Medicaid services (CMS) effort on basing reimbursement on quality as it moves from voluntary reporting of quality measures to mandatory reporting, basing reimbursement on the data reported. Presently, post-acute providers are paid on a fee-for-service basis but with the IMPACT act, bundle payment will replace the fee-for-service. The bundle or value based payment pays for outcomes and not for the volume of services. The Act gives post-acute providers an incentive to work on

According to L. Horton, LTACHs are funded by commercial insurance, Medicare, and charity (personal communication, March 7, 2014). For claims reimbursed by Medicare, patient satisfaction survey’s or Hospital Consumer Assessment of Healthcare Providers and Systems/HCAHPS help determine the hospital’s reimbursement scores. Value Based Purchasing (VBP) was established by the Affordable Care Act, which implements a pay-for-performance approach to the Medicare payment system (“Linking Quality to Payment,” n.d.). This program can help hospitals evaluate the performance of the services they provide to the public. Part of the VBP plan includes a questionnaire to patients that determines 30% of the weight of the hospital’s reimbursement scores. There are eight measures included in the HCAPS: nursing communication, doctor communication, responsiveness of staff, pain management, communication of medications, discharge information, cleanliness and quietness of hospital environment, and overall rating (Grellner, 2012, p.57).

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:

Since 1993, the Truven Health 100 Top Hospitals program has used both independent and objective research to guide hospital and health system performance. In this process, they analyze public data sources to compare hospitals to similar organizations. The 100 Top Hospitals program uses a balanced scorecard that incorporates public data, proprietary, peer-reviewed methodology and key performance metrics to arrive at an objective, independent analysis of hospital or health system performance. This research measures performance, organizational alignment, progress

On July 23, 2013, appellant, Jason Shoemaker (“Mr. Shoemaker”) was awarded an absolute divorce from appellee, Fallon Shoemaker (“Ms. Shoemaker”). The trial judge incorporated a voluntary separation and property settlement agreement signed by both parties into the judgment of absolute divorce. Thereafter, on May 6, 2014, the parties modified their separation agreement by executing and filing a consent order with the circuit court. On July 17, 2014, Ms. Shoemaker filed a petition for contempt alleging that Mr. Shoemaker breached the consent order.

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.

A two-tail t-Test was conducted to compare the individual vendor strategies to the calculated efficiency ratio. Three critical data points are used as a mean of testing the validity of the hypothesis: the t-Stat, critical value, and p-value. In the data if the t-Stat value is greater than the critical two-tail value then the null hypothesis (Ho) is rejected in favor of the alternate hypothesis (H1). In the first data point, comparing single-vendor strategies to best-of-suite, the t-Stat was -1.46 and the critical value was 2.26; therefore, because the t-Stat is smaller than the critical value the null hypothesis cannot be rejected and the data supports H0 that single-vendor strategies do not increase hospital efficiency more than best-of-suite. The same holds true when single-vendor is compared to best-of-breed; the data shows a t-Stat of 0.098 and a critical value of 2.11.