Value Based Purchasing In Healthcare

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

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.

The surveys are meant to be specific and consistent and are not just used to evaluate the organizations for improvement but are also to educate in the best practice standards adopted throughout health care and to help staff in ways to continually improve an organizations performance. For this purpose, in 1996 the Quality Check website was launched to help the Joint Commission provide information regarding the performance of accredited organizations to consumers and organizations. Users are able to search for accredited or certified organizations; they can locate organizations by either type of service or geographical area and lists of certified organizations as well as a hospital’s performance measures can be obtained.

In addition, it also measures the quality of care and patient satisfaction. In 2015, the US Secretary of HHS has announced a goal of 85 percentages of Medicare Fee for Service payments tied to quality or value. In addition, many new payment models are associated with HRRP; for instance, forthcoming Skilled Nursing Facility VBP program and Dialysis Adequacy measure , potentially specifies preventable readmission measures. As the system is moving from quantity to quality, it is beneficial to implement quality of standards to optimize future benefits for the community and Central Health as well. Currently, Central Health has higher readmission rate than national average with an overall rating of 2 out of 5. Penalties incurred due to below standard of care could strain hospital resources to utilize for the betterment of our facility. Furthermore, the incentive structure has concerned Central Health to reevaluate the mode of practice and care provided engaging healthcare providers and patients. Central Health is committed to reducing readmission rates by identifying and sharing best practices for long term benefits. Given the flexibility of penalty under the 21st Cure Act, the initial program will focus on readmission prevention within 30 days of hospital

Quality can be difficult to measure, which is what has halted the strong pursuit of quality in the past. Healthcare organizations use quality assessment to measure quality against some established standard. This includes “defining how quality is to be determined, identification of specified variables... and the collection of appropriate data to make the measurement possible (Shi, 2015, pg. 493). The Affordable Care Act set new standards and incentives for achieving quality of care. This includes offering Medicare reimbursements for hospitals with low readmission rates, and ensuring that (not-for-profit) hospitals complete a community health needs assessment (to ensure that the needs of the community are being met) and by implementing HCAHPS scores, which measures efficiency and efficacy of care using patient surveys. HCAHPS and hospital readmission good example of how quality of care can be measured in efficiency as well as

Quality of service should be one of the most important and well monitored goals for any medical facility, from your small town family doctor’s office, to nursing and rehabilitation facilities, all the way to large hospital systems. The quality of service provided in a facility doesn’t just affect the patients. Quality of service also affects the bottom line, or whether or not the hospital system is profitable. In order to better access the system’s current quality of service and to devise improvement plans I would need to explore issues that have significant effect on quality of care such as, patient satisfaction and retention, medical errors

NHS quality improvement programs main purpose is to collect and review data entered in order to recognize the opportunities to improve business operations in healthcare. To bring changes in quality, it is necessary to respond to patient’s ideas and implement them for the better results. The key issues that are to be considered for quality-improvement NHS program, as it moves forward are the needs for the patients, necessity of the funds for quality improvements, needs of the service providers and expectations of the community. Outcomes for people and also change expertise. And to improve business operations in healthcare and also recognize opportunities.

HCAHPS survey is a patient satisfaction survey required by CMS (The Centers for Medicare and Medicaid Service for all hospitals in the United States. HCAHPS identified the attributes of affective support, health information, and quick response as the elements of nursing care in the interaction and relationship between patient and nurse that determine patient satisfaction. High score of these elements would increase the hospital competition.

The Centers for Medicare and Medicaid’s (CMS) Value-Based Purchasing program (VBP) was implemented in 2012. This program adjusts what CMS will pay hospitals based on the quality of care hospitals give patients. The value-based purchasing is a financial incentive for hospitals to get and maintain higher patient satisfaction scores.

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.

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).

The JCAH also entails that quality assurance data should be frequently revise in order to be qualifying for reaccreditation. These data should include but not limited to “mortality rates by department, hospital-acquired infection, patient fall, adverse drug reaction, unplanned returns to surgery and hospital-incurred trauma” (Hood, 2017, p 477); this method show that hospital are compliance with the JCAH standard. Consequently, it also gives the JCAH a tool to compare hospital performances to other health care

The Computerized Provider Order Entry is effective program to help organization improve quality measures and financial margins. The CPOE is effective program; which monitors a hospitals current performance and calculates methods of improvement. For example, Trinity Hospital a leader in clinical intelligence to track and report across it members hospitals on systems wide quality measures (Balgrosky, 2015). The Clinical Provider Order Entry will help patients compare programs graded by the Center for Medicare & Medicaid and Hospital Quality Assurance. This program will further enhance the patient-centric model because patients will have comprehensive comparison of hospitals to make informed medical decision as to where they would like to receive treatment. The quality measures monitor readmission, complications, patient’s experience surveys and other categories. Patients are interested in receiving health care in top-notched care facilities that address their needs. Consumer needs are very important because translating into referrals by word-of-mouth or rankings. Technology plays a major role in an organization's success with supports Judy Murphy idea of enhancing patient’s health information technology

Through statistical analysis, there were ten AHRQ inpatient quality indicators that are statistically different from that of the reference population. To determine which ones were significant, the reference population was compared to the risk-adjusted confidence interval. Those whose reference population was outside the risk-adjusted confidence interval were deemed as significantly different. These ten indicators are listed below in Table 1.

Governmental agencies such as JCAHO monitor the care of the patients from a nursing perspective. Quality of care affects the amount of reimbursement for care given to the hospital (Baernholdt, Jennings, Merwin, & Thornlow, 2010). The neighboring community often times depends on the hospital to meet their needs. The amount of people in a certain location may influence when and where the hospital is built. Competition from other nearby hospitals may be another consideration that influences types of care given in the hospital. External forces can add to the strength of the hospital by providing support and monetary compensation. A hospital, however can be weakened when certain rules are not followed, and the hospital receives a fine.