Pay-For-Performance Programs (PFP) are put in place to properly rate the effectiveness of the healthcare quality and related costs in all aspects of the healthcare industry, like with the day to day healthcare operations in Primary Care Providers (PCP) offices, healthcare clinics and private or public hospitals. Once all research data, reports and surveys are completed and collected, the managers of the Pay-For-Performance Programs, which are ran by both private and government entities will make changes or keep in place current Pay-For-Performance procedures. Both private and government ran PFP Programs will pick one area of healthcare operations like with the case of evaluating the survival and inpatient mortality of patients, who have been diagnose and treated with acute myocardial infarction (AMI). They will compare research data from patient cases from and research pool of 1000 hospitals over one year period and then compare these healthcare operation results, with data from Joint Commission Core Measures databases that will cover a two to four year period of research. Then the PFP managers will create the composite score formula, which is base on the Centers for Medicare and Medicaid Services Methodology scoring procedures, then statically compare these numbers with the research data that comes from using a set alternative scoring method that was used during the conducted AMI research (Glickman, et al., 2009). This type of conducted research will measured or compared two variables like clinic procedures and administrative procedures direct effects on the mortality rate of patients who have been treated and diagnose with AMI. Results from past conducted AMI research shown the…
It provides care throughout eight regions in the United States and is the single largest…
The current competition in today’s health care is not aligned with patient value, but the financial success of healthcare businesses. One of the most encouraging points Porter made in his lecture was his emphasis on quality improvement. Port believes…
In October 2012, the Centers for Medicare and Medicaid Services (CMS) is implementing the Hospital Value-Based Purchasing (VBP) Program. This initiative will reward acute-care hospitals with incentive payments for the quality of care they provide to people with Medicare. This means that DRGs are still in place, but incentives can be reached based on how well the hospital performs on certain quality measures, or how much the hospital’s performance improves compared to its…
The purpose of this research is to inform the healthcare industry how lowering costs in health care will impact healthcare organizations. This…
Centers for Medicare and Medicaid Services (CMS), is clinical indicators focused on improving clinical outcomes. CMS is concentrated on physicians, nursing homes, long - term care facilities, home care, and hospitals. The information obtained can be compared to other hospitals and target locations, medical conditions, outcomes, surveys, and payment information. Giving administrators and researcher’s valuable information directed toward positive or negative outcomes (Wager, Lee, Glaser, & Burns, 2009).…
Pay-For-Performance is a health care payment system developed to try and address the shortfalls of the current reimbursement payment system. Incentives are paid to hospitals, physicians, and clinics for the improved quality of care for patients, efficiency of care, and improved health outcomes of patients. Pay-For-Performance is part of the improvement of quality as well as a cost management tool. Currently the reimbursement system that is in place pays for services rendered prompting providers to order tests or services that may not be necessary but offer them a better reimbursement. Pay-For-Performance will pay for the improved treatment and health of a patient, so instead of just ordering a bunch of services providers will focus more on…
ACOs are expanding outside of the Medicare setting and private health insurance companies are considering or trialing the use to decrease expenditures. The overall hope is that ACOs will bring HCPs, hospitals, and the interdisciplinary team to work together to improve quality and decrease healthcare expenditures (Fischer & Shortell, 2010).…
Clinical quality standards should be developed through a bottom-up approach, in collaboration with the Federal Government, health care professionals and public health and social care practitioners, accrediting societies, medical societies and boards, insurers, and service users. However, it’s important to recognize that the vexing problems of quality care and cost-effectiveness in the U.S. health care system are unlikely to get resolved without the leadership from the Federal Government. Ideally, leadership would naturally surface from within the industry to lead the development of quality care standards, but the fragmented health care…
Both the Patient-Centered Medical Home and Accountable Care Organization models are focused on improving the quality of care while coordinating with qualified practitioners and medical providers. They both encourage…
Some concerns of hospitals are surviving in a competitive world. Bringing in the right stakeholders, donators. Also achieving the highest reimbursement from private and state and local insurances. In today’s economy there are many urgent care and private facilities, which patients and consumers along with residents can choose from.…
|1996 |HIPPA 1996 Act was passed, and is the federal law that establishes standards for the |…
The health care system in western Oregon has identified the need to implement Language of Caring to support improvements in patient experience of care scores, or Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores. “The Language of Caring Skill-Builder System aims to expand and strengthen staff communication skills so that the dedicated people on your care and service teams more effectively and more frequently make their compassion and caring felt by the people they serve” (The Center for Health Affairs, n.d., para. 1). The program consists of nine modules: heart-head-heart communication, the power of presence, acknowledging feelings, showing caring nonverbally, explaining positive intent, the blameless apology, the gift of positive regards, the caring broken record, and the skills combined (The Center for Health Affairs, n.d.). The Centers for Medicare and Medicaid Services (CMS) made a decision in 2013 to publically report patient experience of care scores (Oregon Health Authority, n.d.). Value based purchasing paved the way for mandated reporting through the introduction of the physician compare web site, and patient centered medical homes, as a response to the Accountable Care Act mandates. Pay for performance is the reimbursement structure supported by the accountable care organizations in which the state of Oregon supports robustly. The…
References: Niall Brennan, Nichole Cafarella, S. Lawrence Kocot, Aaron Mckethan, Marisa Morrison, Nadia Nguyen, Mark Shephard and Reginald D. Wiliams. (2009). improving quality value in the U.S. Health Care System. Retrieved August 2009, from www.brookings.edu/reports/2009/08/21-bpc-qualityreport…
American Hospital Association. (2011). "The Work Ahead: Activities and Costs to Develop an Accountable Care Organization." American Hospital Association, 1-17.…