The Perception Of Quality And The Reimbursement Of Services

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

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

Definitions of the quality of medical care are no longer left to clinicians who decide for themselves what technical performance constitutes “good care.” What are the other dimensions of quality care and why are they important? What has changed since the days when “doctor knows best?”

Centers for Medicare and Medicaid Service (CMS) provides health coverage through Medicare, Medicaid, Children’s Health Insurance Program, and the Health Insurance Marketplace. “The CMS seeks to strengthen and streamline the Nation’s health care system, to provide access to high quality care and improved health at lower costs” (CMS Quality Strategy, 2016). The CMS provides health insurance to those who are uninsured or underinsured to those who are low-income families, adults, seniors, and people with disabilities.

The United States health care system has can be assessed for quality measures in many different ways such as mortality rate or infant mortality, but the United States government often judges the efficiency of health care provider or network on the Centers for Medicare & Medicaid (CMS) core measures. The reason the United States gauge health care performance on CMS standards is due to CMS is the federal governing body that operates Medicare and how the hospital will be reimbursed from Medicare patients. Formerly Medicare would reimburse a hospital based all services the hospital provided a patient or fee for service (FFS). The rising

The Centers for Medicare and Medicaid Services is a government agency within the U.S. Department of Health and Human Services. The CMS is in control of certain health care programs. Reimbursement is used in the healthcare field by coding specialist in hospitals and physicians’ offices. These specialists assign appropriate diagnosis and procedure codes based on the patients’ individual medical record. Once the information from the patients’ record is coded, a bill or claim is composed and sent to a third-party payer for the reimbursement of the services that were performed on the patient. Depending on the payer, they may request that a copy of the patients’ medical record be sent with the claim.

Healthcare has become a consumer driven industry with patient satisfaction equating to good customer service. Effective communication has been shown to be a key factor in both patient outcomes and satisfaction. Additionally, patient satisfaction has become a tool used by insurers to evaluate medical facilities and may impact reimbursement to hospitals for patient care. In this paper, I will discuss the issue of ineffective communication in the waiting area of the surgical services department at Mount Carmel East Hospital. The impact of ineffective communication effects patients and members of the perioperative team. Results of patient surveys

An interesting perspective on the definition of quality which would be interconnected with any managed care plans was highlighted by Carolyn M. Clancy, Director Agency for Health Care Research and Quality, U.S. Department of Health and Human Services in a subcommittee hearing to the U.S. Senate. The statement by Carolyn M. Clancy was presented on: March 18th, 2009 when discussing the topic of: What is Health Care Quality and Who Decides?

One key concern for policy makers, regulators, care givers and patients is healthcare quality (Harnett, 2016). Quality problems are reflected in a variety of ways for the use of healthcare services, the underuse and overuse of some services, and misuse of others. Waste and inefficiencies have negatively affected the healthcare system. Improving the quality of healthcare and reducing medical errors is a priority for many organizations that regulate the healthcare industry. Many are looking for the highest quality of care they can get, as quickly as they need it. Lots of attention has been placed on the healthcare quality improvement by payers, clinicians and consumers. There is a big interest in patient outcomes and safety, care coordination, efficiency, and cost cutting. Healthcare is more vital to people than most other goods or services, and we have a strong collective interest in assuring that the healthcare system works as well as it can. The consequences of poor quality can be dire. Another reason is that people spend a lot on healthcare and these costs continue to rise. Scores of provider quality measures have been developed by accreditation organizations, regulators, payers, and healthcare providers themselves to measure specific areas of practice and performance. Measuring the quality of healthcare is important because it tells how the health system is performing and leads to improved care (Uyar &

Hospital Compare is a database that is available to the public and allows one to review the quality and satisfaction of specific hospitals in comparison to one another. Value Based purchasing is part of the Centers for Medicare and Medicaid (CMS) payment system that ties quality measures to reimbursement. The NDNQI is a National database that collates outcome indicators that are specifically nurse sensitive. The numerous measures and reports that the facility

Quality indicators enable the health care system to identify inferior care in both process or outcome and structure while enhancing quality improvement in health care (De Vos et. al, 2009, p.1).

Evaluating hospital quality data is part of the evolution of health care today. There are publicly reported statistics from every surrounding health care system and can be found on reliable websites like www.Hospitalcompare.hhs.gov. This paper will review a local hospital and two of its competitors and evaluate the pros and cons of these publically reported indicators for the Process of Care.

Professionalism, respect, empathy and support are parts and parcel of the process dimension of quality of care. Access, availability and information provision have been found to be associated with patients’ satisfaction. Those indicators largely reflect the doctor-patients’ communication process. The more centered, empathetic, respectful and complete the process is, the higher the levels of satisfaction are expected. Several studies indicated that lower communication levels, inaccessibility and passivity were associated with lower levels of satisfaction. Interpersonal skills among the medical staff was also noted to impact levels of satisfaction among patients where more qualified, respectful and caring staff generated higher scores of

Quality Measures otherwise called CQM 's are an instrument for evaluating perceptions, medications, procedures, encounters, as well as results of patient consideration. At the end of the day, CQM 's survey "the extent to which a supplier capability securely conveys clinical administrations that are proper for the patient in an ideal time period which is a prerequisite as a component of significant use necessities for the Medicare and Medicaid Electronic Health Record motivating force programs. According to Medicare.gov, (n.d.), quality measures demonstrate how frequently patients who are hospitalized for specific conditions experience difficult issues not long after they are released.

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.