Value Based Purchasing & Quality Measures for Hospitals
Value Based Purchasing & Quality Measures for Hospitals essay assignment
Value Based Purchasing & Quality Measures for Hospitals essay assignment
Provide a meaningful response to two other posts:
1- Value-based programs are a great thing for health care workers, the fact that they get payments or incentives for the quality of care, creating an environment where there is a emphasis on being precise, and consistent. This is what value based care is wanting to place great emphasis on. These programs are part of the larger quality strategy to reform how health care is delivered and paid. Value based care aims for : better individual care, better health for individuals and lower cost. United, Anthem and Aetna are other payers that follow the CMS guidelines, they are have contracts with hospitals through different time periods. They will have their own payer specific data such as safety indicators and many have readmission component similar to CMS where they don’t pay for the second hospital admission which is for the same reason which is different from CMS where they are cause readmission or in the penalty.
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Based on the three used as an example for this instance, Anthem would be the more well known insurance providers. Anthem is one of many that are well known for their measures for their measure on quality and how many people that use their insurance plan. Anthem has a lot of structural measures such as asking the hospitals to prove that they have certain policies and practices in place or that they offer certain services for to their patients. Though it can be annoying for the health care providers, it works for Anthem and their customers. This is to make sure they are receiving the right care and not wasting money on unneeded test &etc. As for United, they are unique because they are mostly focused on primarily on utilization such as patients going to the ER readmission rates and etc. Many hospitals aren’t able to prevent readmission, however they have to still put their best foot forward and show they provided the best care they could the first time with that patient. Therefore even leading to some instances hospitals not being paid by the insurance company due to that readmission.
As for Atena, it is a mix of the two as they include a lot of the CMS measures but also have some unique cost metrics that others don’t include. Overall, each program determines what payers to include. Anthem gets all their data from CMS therefore is a mix of all payer and Medicare patients. United uses only their own data so its only United patients. Aenta is a mix, combination of some of the data from CMS and some data they collect themselves for only beneficiaries . They all have their own measures in making sure they are providing the best for their patients, which is a unique way of to keep health care workers accountable and incentives for the best care. The value based program and these commercial programs are positives for all those involved: the insurance companies, customer(patience) and health care.2- The CMS Hospital-Acquired Condition (HAC) Reduction Program is a Medicare pay-for-performance program that links Medicare payment to healthcare quality in the inpatient hospital setting to achieve the goals of reducing hospital acquired conditions, improving patient care, and reducing healthcare costs. Hospitals with a total HAC score greater than the 75th percentile of all total HAC scores, who are considered the worst performers, are subject to a one percent reduction in payment. CMS evaluates two domains when calculating hospitals’ total HAC scores. Domain 1 focuses on the CMS Patient Safety Indicators 90 measures score (PSI 90) which is comprised of 26 measures that highlight safety-related adverse events occurring in hospitals following operations, procedures, or childbirth. PSIs are determined by data from the AHRQ. Domain 2 is comprised of the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) hospital-associated infections (HAI) measure scores including central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infection (CAUTIs), surgical site infections (SSIs), and infection rates from MRSA and C. Difficile. Each hospital is assigned a score based on a weighted average of these measures which is then compared to the HAC scores of all other hospitals. Those who score in the bottom 25% of performers are penalized with a 1% reduction in payment by CMS. The penalty for this program, unlike other pay-for-performance measures, is “all or nothing” comparable to a “pass or fail” grade. Because lower performing hospitals are consistently penalized regardless of individual improvement year over year, one could argue that this program fails to recognize improvement efforts made by lower performers. This lack of recognition for improvement means that there inevitably must always be a lowest scoring 25%, regardless of the actual quality of care in those hospitals. In reality, there could be very little statistical difference in scores between those in the lowest 25% and those above. Perhaps an alternative could be to determine a benchmark to which hospitals are rewarded for exceeding, and not penalized unless they fall below. If a bonus system is desired, those in the top 25% of performers should be rewarded instead.
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