Value Based Health Care : Transition Of Care

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,

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

The care delivery enterprise must be re-tooled so that it functions in a fee-for-value reimbursement environment as is has in a fee-for-service reimbursement environment. The Centers for Medicare and Medicaid Services (CMS) is leading the

This model reimburses hospitals based on quality of care instead of the volume of patients. The quality of care is assessed by patient questionnaires and if hospitals are unsatisfactory penalties may be imposed (Edwoldt, 2012). The value-based system also affects Medicare and Medicaid. It was reported that Medicare readmissions within 30 days of discharge cost 17 billion dollars annually (Edwoldt, 2012). Due to the high costs of readmissions Medicare and Medicaid have implemented a Hospital Readmission Reduction program. A formula is utilized to evaluate readmission rates within 30 days of discharge for any medical reason related to their original admission such as heart failure and pneumonia. Upon review the hospital is potentially penalized. It is important that nurses strive to provide excellence in care despite their beliefs on the ACA. Nurses have the ability to provide a safe patient environment and reduce the risk of hospital associated infections by following hospital protocols such as hand washing.

Through the history of health care, the standard of care changed from protecting our patient from injury and illness to a systemic entity to make money for insurance companies. Access to services and clinical outcomes are dependent on what health insurance providers will “pay” for in a clinical or community setting; as a result, patient safety, care and satisfaction has been negatively impacted.

Reading and understanding the information that was given in our text book about transforming the healthcare system for improved quality, rely on enhancing the value on healthcare. Their ideas is to improve healthcare in both financial and clinical aspect that could adjust the quality of healthcare. Meanwhile, if hospitals, doctors, and medical team. improve the value base care, it can or may provide better care, better health and lower cost. According to the Aetna the solution is to provide and deliver better health and more

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

Cost shifting is a challenging trend that the United States healthcare system is currently facing. The

As expense for-volume offers approach to charge for-worth, doctor 's facilities and social insurance frameworks are finding that their time-tried blocks and-mortar development methodologies will no more serve their long haul objectives. Today 's quality driven clinical and plans of action require a movement in center — from experience based solution to populace wellbeing administration. Systems to advance development — fundamental for quality based achievement — will depend on patient maintenance and new instruments for picking up piece of the pie.

As the nation moves in the direction of practical application of the Patient Protection and Affordable Care Act, understanding the capability of change will require tremendous uplift of the American human services conveyance. Keeping that in mind, the new law looks to reinforce the country 's essential care establishment through upgraded repayment rates for suppliers and the utilization of imaginative conveyance models, for example, persistent focused medical homes. Evidences recommend that these methodologies can return considerable advantages to both patients and suppliers by expanding access to essential care administrations, decreasing regulatory limitations and loads, and encouraging coordination over the continuum of care (Davis,

One of the major goals of the ACA is to improve quality of care by using a value-based system. Nationwide, nearly 3,500 short-term acute-care hospitals are reimbursed under the Inpatient Prospective Payment System (IPPS). Within the IPPS is the Hospital Value-Based Purchasing Program is (VBP). This program “rewards acute care

Paradise Hospital, Inc. is a for-profit hospital. As the facility’s new hospital administrator, you have been tasked with improving the service value of the hospital. The administration has not done this process since the hospital began operating in the year 1995. The investors are not familiar with the value proposition strategies of hospitals in the current day America.

Managing the growth of allied health care sector in the United State. Healthcare delivery system changings are most effectual when they are cohesive and ensure real answerability from providers to patient to improve outcomes. With the expected increase in allied health staff in the healthcare organizations, the first need will be to ensure that the care provided to patients is not impacted in anyway. Hiring new allied health staff allows organization to provide to provide adequate care for patients, but it also increases the cost to provide care. This means that recovering the financial costs of care and minimizing the cost of care takes a higher priority. Evidence proposes that multiple methods to delivery system changes may be necessary bend the cost curve and improve care quality. For example, the efficiency of a single disease administration program may be limited for patients who have multiple chronic conditions and who require coordinated care from many

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.

Hospitals and health systems in the U.S. are experiencing a remarkable transformation in their business models directed from numerous influences that are projected to ultimately turn the industry around. Pressures include providers troubled with the quantity of services they are responsible for, to providers who concentrate on presenting high-cost services that give emphasis to sustaining healthy populations (Dunn & Becker, 2013).