Incentive Programs in Healthcare Discussion
I don’t know how to handle this Health & Medical question and need guidance.
Each reply must be at least 450 words a peice. Each thread and reply must contain at least 2 references and 1 instance of biblical integration. Current APA format must be used.
Colossians 3:23 says, “Whatever you do, work heartily, as for the Lord and not for men.” As a part of quality assurance, the government has instilled various programs as incentives for various health care facilities and health care professionals. Like the Meaningful Use program, other programs that are offered by the government “look to incentivize healthcare providers through demonstrating the delivery of quality healthcare and a commitment to quality patient outcomes” (Harrington, 2016, p. 269). Holmstrom (2017) reported that an incentive program or system that is properly designed will consider the full collection of services that a healthcare provider or facility “can engage in, the array of instruments, many nonfinancial, that are available to influence individuals and consider the factors that motivate them in different settings” (p. 1735). Two of the incentive programs that we will look at further are the Pay-for-Performance (P4P) program and the Value-Based Purchasing (VBP) program. Both programs are based on quality care, but P4P deals with healthcare providers while VBP deals with acute care hospitals.
Up until the 1990s, healthcare providers were reimbursed based on a fee-for-service system. Entering into the 1990s, healthcare payers shifted to a managed-care approach that included primary care physicians and case managers. With the continued escalating healthcare costs with little to no improvement in the quality of healthcare services, the P4P payer system was introduced in the early 2000s. When healthcare providers meet or exceed agreed-upon quality measures or performance goals, they will be provided with a bonus from the P4P program (Harrington, 2016). Healthcare providers can also be penalized for not providing quality care, not reducing healthcare costs, and even performance that is not improving. This places pressures on the healthcare providers to ensure that any healthcare services provided to patients are “safe, effective, patient-centered, timely and efficient in its delivery, and equitable for the patient” (Harrington, 2016, p. 271). Quality measures that are imposed on healthcare providers are categorized as process measures, outcome measures, patient experience, and structure measures. P4P payments to service providers are then calculated based on services rendered, the quality of services, and efficiency measures. Harrington (2016) stated that the overarching goal for the P4P program is to accurately align both the incentive program itself and the payment to providers’ processes and goal in order to eventually “produce better outcomes for the patient that will ultimately result in lower costs for the payer, provider, and patient” (p. 273). In comparison, the VBP program bases its program on a majority of the same provisions, but the program operates and requires different measures to differentiate warrant of payment.
The VBP program is an initiative by the Centers for Medicare and Medicaid Services (CMS) “that rewards acute-care hospitals with incentive payments based on the quality of care that they provide to the beneficiary/patient that is on Medicare while in” the health facilities care (Harrington, 2016, p. 274). The VBP program essentially rewards healthcare providers for delivering both quality and efficient clinical care. The VBP program can be complex but basically, any incentive payment is based on how well inpatient healthcare services perform based on each measure or on how much improvement, or lack thereof, has been made in that specific area since the previous measurement or baseline period. Just as in P4P, there are a handful of quality domains that hospitals are measures on, these include—the clinical process of care, patient experience of care, outcome, and efficiency. Any healthcare facility that participates in the VBP program is not only under a microscope, so to say, but also their performance is completely transparent to the public. Information gathered on a hospital’s performance in the VBP program is posted periodically for public review. This information includes “the hospital’s performance on each measure that applies, the hospital’s performance on each condition or procedure, and the hospital’s total performance” (Harrington, 2016, p. 278). Chee, Ryan, Wasfy, and Borden (2016) reported that VBP programs “will play a significant role in healthcare delivery for years to come, and they will serve as an opportunity for providers to build the infrastructure needed for value-oriented care” (p. 2197). Both the VBP program and the P4P program have initiated measures for improving the quality of healthcare services and healthcare professionals’ performance, while aiming at reducing healthcare costs. The overall impact of both the P4P program and the VBP program on any healthcare organization that is participating is that the overall financial health of the healthcare organization is directly affected by any unfavorable outcomes.
American Bible Society. (2000). The holy bible, containing the old and new testaments.
Chee, T. T., Ryan, A. M., Wasfy, J. H., & Borden, W. B. (2016). Current state of value-based purchasing
programs. Circulation, 133(22), 2197-2205. doi:10.1161/CIRCULATIONAHA.115.010268
Harrington, M. K. (2016). Health care finance and the mechanics of insurance and
reimbursement. Burlington, MA: Jones & Bartlett, 2016. ISBN: 9781284026122.
Holmstrom, B. (2017). Pay for performance and beyond. American Economic Review, 107(7), 1753-1777.
Incentive Programs in Healthcare Discussion
Incentive Programs in Healthcare Discussion
The U.S. health care delivery system does not provide consistent, high quality medical care to all people (Institute of Medicine, 2001). Americans should be able to count on the quality of care they pay for, as to meet their needs and are based on the best scientific knowledge (Institute of Medicine, 2001). To initiate process of change in the area of quality, there is a need for changes in the areas of applying evidence to health care delivery; using information technology; preparing workforce; and aligning payment policies with quality improvement (Institute of Medicine, 2001).
It has been widely adopted by health care providers, and it seems it would improve the quality of care, however, research finds very mixed evidence of that result, as there is no evidence between P4P and actual improvement of quality, nor the evidence exists that hospitals, which improved in some areas, were able to sustain the improvements (Warner et al., 2011). Studies from U.S. fail to find any improvements made in care process, however, the P4P did decrease readmission rates for Medicare beneficiaries (Mendelson et al., 2017).
The Hospital Value Based Purchasing (VBP) Program is a CMS initiative that rewards acute care hospitals with incentive payments based on the quality of care that they provide to Medicare beneficiary under their care (Harrington, 2016). The VBP was established under the ACA in 2010 and begun applying its payments for the fiscal year 2013 and had an impact on 2,985 hospitals across country (Harrington, 2016). There are about 3,000 hospitals across country that are eligible for VBP (Harrington, 2016), which are penalized or rewarded based on how well they perform on certain quality measures. VBP refers to a set of performance-based payment strategies that link financial incentives to health care providers’ performance on a set of defined measures to achieve better value (Damberg et al., 2014). VBP program excludes some hospitals that do not have a minimum number of cases from participation, like psychiatric institutions, oncology centers, or pediatric facilities; and hospitals that do not participate in the Hospital Inpatient Quality Reporting Program (Whitman, 2016). This year, CMS announced several changes to VBP, introducing four domains on hospital scores, with patient and caregiver centered experience and care coordination; safety; efficiency and cost reduction, removed two measures from clinical care and added a care transition dimension (Whitman, 2016).
Past decade has been a one big experiment with pay-for- performance payment systems, primarily with P4P. However, we still know very little about how to design and implement VBP programs to achieve stated goals and what constitutes as a successful program (Damberg et al., 2014). As of today, hospitals are assessed based on comparison to its peers and its own performance over time. According to research, about 1,600 hospitals will see bonuses from Medicare in 2017 under VBP (Whitman, 2016). The lowest performing hospitals will see a reduction in DRG payments of 1.83%, and the highest performing hospitals will see an increase of more than 4% (Whitman, 2016). Compering numbers of hospitals from 2016 to 2017, numbers of hospitals that payments were deducted grew from 1,236 to 1,343, accordingly (Whitman, 2016). According to researchers and critiques of VBP, this design has a flow, as it set up as a tournament style, in which hospitals are stacked up against each other, and really do not know how they perform until very end (Whitman, 2016). With this year’s changes in major domains on which hospitals are scored, we will gain new perspective on how progress on quality can be accelerated when pay-for-performance programs reward both achievement and improvement (Whitman, 2016).
Since we are discussing pay for performance programs, I thought it was fitting to talk about earthly rewards. In the bible there is a scripture that says, “whatever you do, work heartily, as for the Lord and not for men, knowing that from the Lord you will receive the inheritance as your reward. You are serving the Lord Christ” (Colossians 3:23-24, NIV). Everything that we do as healthcare administrators we should look at it as a service to the Lord. We should do it gladly and to the upmost of our ability. We are his servants as we do his will on earth the reward is the individual that we bring to Christ just based on our day to day operations. The pay for performance program is set up the same way as the bonus or reward is based on exceeding the quality standard that is set.
Damberg, C., Sorbero, M., Lovejoy, S., Martsolf, G., & Mandel, D. (2014). Measuring
success in health care value-based purchasing programs: Findings from an environmental scan, literature review, and expert panel discussion. RAND Health Quarterly. Vol. 4, No. 3. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC51613…
Harrington, M. (2016). Health care finance and the mechanics of insurance and reimbursement.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st
century. National Academies Archives. Retrieved from: http://www.nationalacademies.org/hmd/~/media/Files…
Mendelson, A., Kondo, K., Damberg, C., Low, A., & Kansagara, D. (2017). The effect of P4P
on health, health care use, and process of care: A systematic review. Annals of Internal Medicine. Retrieved from: http://annals.org/aim/fullarticle/2596395/effects-…
Warner, R., Kolstad, J., Stuart, E., & Polsky, D. (2011). The effect of P4P in hospitals: Lessons
for quality improvement. Health Affairs. Vol. 30, No. 4. Retrieved from: https://www.healthaffairs.org/doi/full/10.1377/hlt…
Whitman, E. (2016). Fewer hospitals earn Medicare bonuses under value-based purchasing.
Modern Healthcare. Retrieved from: http://www.modernhealthcare.com/article/20161101/N…
Incentive Programs in Healthcare Discussion
Incentive Programs in Healthcare Discussion
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
ADDITIONAL INSTRUCTIONS FOR THE CLASS
Discussion Questions (DQ)
Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality
Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes
I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.