The Institute Of Medicine 's A New Health System For The 21st Century

Pay-for-performance payment model – healthcare payment systems that offer financial rewards to providers who achieve, improve or excel their performance on specified quality of care and cost measures (HealthCare Incentives Improvement Institute, N.D.)

The three significant pay-for-performance (PFP) initiatives in the United States are the Leap Frog Group’s Hospital Rewards Program, Bridges to Excellence and the Medicare PFP initiatives. The leap frog website states, that their program is “an initiative driven by organizations that buy health care who are working to initiate breakthrough improvements in the safety, quality and affordability of healthcare for Americans”. The Leapfrog Group was founded by a small group of large employers in 1998.

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.

The Quality Chasm report underscores the lack of quality healthcare, cost concerns, poor use of information technology, absence of progress in restructuring the health care system, and the underutilization of resources (Stevens, et al., 2006). The quality issue that this writer has chosen to address is the poor use of information technology. According to the Quality Chasm Report, health science and technology have advanced at a very rapid pace, but due to poor use of information technology, the healthcare delivery system has not maintained delivery of high-quality healthcare services. Research results are not translated into practice, and practice lags behind knowledge (Stevens, et al.,

management tools to address service complaints and suggestions for improvement. The popular and renowned To Err is Human noted health professionals, society at large, and overall persons populated regions in America pay costs for industry policy changes and errors. Limitations in quality health care lead to cost errors, lost work productivity, reduction in children’s ongoing care structures and overall population health status (Kohn, Corrigan, & Donaldson, 1999).To Err Is Human. The point; is we can do better and provide better. How do we measure better?

Change can be devastating and not always everyone agree with it. The biggest transformation in healthcare is the implementation of the Affordable Care Act. With the new health care system the government mandated U.S. citizens and legal residents to have health insurance that resulted in the rise of insured individuals. Due to the new policy more people have access to health care that means more primary physician needed to accommodate the rise of new patients. Shortages of physicians not only in the primary care area but also in specialty care area are projected between 46,000-90,000 by 2025 ("The Physician Shortage," n.d.). The pay-for-performance focuses on quality that will eventually decrease the costs (James, 2012, p. 1). This system will give a reward or a bonus to the health care providers whenever they meet or exceed quality standard that are being set (James, 2012, p. 1). In contrary the system can also penalized those providers that are unsuccessful in providing the indicated goals or cost savings (James, 2012, p. 1-2). There are 2,225 hospitals in 2013 that were fined under the Hospital Readmissions Reduction Program (HRRP) which is part of the ACA regulation (Anderson, 2014, p. 11). For the institutions to survive with the new system a lot of hospitals are merging that a year after the ACA implementation there were already

Medical errors are the third-leading cause of death in the U.S., yet many hospitals and healthcare networks in the United States currently lack non-punitive incentives to change and are failing to actively seek to improve the quality of their services. An example of this is surgical errors. The Joint Commission (2017) provides numerous resources, checklists, universal protocols, and sentinel event alerts related to surgical errors, yet these events cost nearly $20 billion annually in the U.S. (Luthra, 2015). At Texas Health Resources (THR) alone, the state’s largest healthcare delivery institution, 1,820 patients had one or more preventable surgical complications in 2010, quadrupling their median length

There has been much progress to support better quality healthcare in recent years. Focus is around the development of quality measures, thanks to private organizations such as the National Committee for Quality Assurance (NCQA). The NCQA developed what is called the patient-centered medical home model. This is a model of care that emphasizes care coordination and communication to transform primary care into what patients want and need. “The NCQA Patient-Centered Medical Home (PCMH) Recognition is the most widely adopted model for transforming primary care practices into medical homes (NCQA Patient-Centered Medical Home, 2015).” Following the

The challenge of aligning the quality and cost of healthcare has been a thorn in the side of healthcare leaders for many years. A multitude of quality and value issues are imbedded in our complex healthcare landscape, including a lack of primary care providers, physician alignment (or misalignment), disjointed quality initiatives, a lack of decision based support tools, and lack of patient facing data to help patients and doctors make joint decisions. Here we will discuss what I find to be three of the largest roadblocks in bringing cost, quality, and value to American healthcare; misalignment of the payment system and patient outcomes, the burden on physicians to engage in quality and cost-savings initiatives, and a lack of clinical data availability and transparency.

OCS is facing external pressure to improve patient services. These forces come from a variety of sources, but payers such as Medicare and Medicaid are providing some of the greatest pressure. The U.S. spends more on health per capita than any other industrialized nation, yet continues to have worse outcomes than most comparable countries (Davis, Stremikis & Schoen, 2014). This realization has been the force behind public health policy change where the Centers for Medicare and Medicaid Services (CMS) is moving towards payment based on outcomes and quality rather than volume. The intention is that providers are rewarded for better outcomes and the result will be lower costs. This effort is demonstrated in the Accountable Care

As proof, in the publication JAMA (The Journal of the American Medical Association) titled: Actual Causes of Death in the United States, 2000, there have been between 44,000 to 98,000 people that have died each year, all from results of preventable medical errors. If healthcare providers truly understood what quality meant and how to provide it, I think these errors could have been prevented. Now, each organization has to make sure after viewing such reports, that they are offering a concept which focuses on the complete quality system including the providers and the crucial customers of the product or

The success and viability of U.S. healthcare organizations has become increasingly dependent on their ability to provide high-quality care. According to Buttell, Hendler, & Daley, the concept of healthcare quality involves delivering services that increase the likelihood of improved health outcomes for both patients and populations, utilizes the most up-to-date professional knowledge, and meets and/or exceeds the expectations of consumers and payers (2007). This paper will provide a brief overview of the history of quality movement, outline key characteristics involved in quality evolution, discuss process improvement and its relation to quality movement, and investigate the impact that health information technology and Practice-Based Research Networks have had on quality evolution in the U.S. healthcare industry.

The political environment surrounding hospitals is far and away the most important key external driver to the industry. Government funded programs, such as Medicare, Medicaid and the Affordable Care Act, have huge effects on the demand to the industry as they determine how many Americans will be insured. The Affordable Care Act is changing the way hospitals function. “The law calls for an emphasis on patient outcomes and overall patient care, which will change how hospitals are reimbursed for services. Under the new law, hospitals with high readmission rates will be reimbursed by Medicare at a lower rate” (First Research, 2014). In essence, hospitals are being punished by not diagnosing and treating a patient correctly the first time. As a result, hospitals must find highly skilled labor and cutting edge machinery to prevent mistakes which in turn

In the United States, measuring and monitoring the quality of care has been reported to be lacking, given the immensity of this country’s health care sector (Schuster, McGlynn, & Brook, 2005). Despite

In the United States, measuring and monitoring the quality of care has been reported to be lacking, given the immensity of this country’s health care sector (Schuster, McGlynn, &