Linking Payments to Quality Outcomes for Improving Quality of Care (OUTLINE)
Swati Jain
California State University, Long Beach
HCA 502
Professor Lott
Introduction
Institute of Medicine’s (IOM’s) 2001 Report, “Crossing the Quality Chasm”, clearly states that U.S. health care quality fails to meet the established industry benchmarks.7 In order to achieve quality improvement and affordability in health care, The Patient Protection and Affordable Care Act (PPACA or Obamacare) was signed in the year 2010. With regard to PPACA the main purpose of this report is to study the following:
Study of health care payment models:
Fee for Service vs. Pay for Performance
Pay for performance programs before PPACA
Quality measures used in pay for
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Health plans realigning their payment policy imitating medicare
Change in physician fee structure
Preliminary Reference List
1. American Hospital Association: http://www.aha.org/
2. ATS Journals (access provided by CSULB): http://www.atsjournals.org.mcc1.library.csulb.edu/doi/abs/10.1164/rccm.201302-0404ED?journalCode=ajrccm#.VBZe7mRdVP8
3. California HealthCare Foundation: www.chcf.org/topics/quality
4. Center for Medicare Advocacy, Inc: http://www.medicareadvocacy.org/InfoByTopic/QualityOfCare/10_06.24.ReformAndQuality.htm
5. Centers for Medicare and Medicaid services: http://www.cms.gov/apps/docs/aca-update-implementing-medicare-costs-savings.pdf
6. HealthAffairs.org: http://content.healthaffairs.org/content/23/2/127.full , Health Aff March 2004 vol. 23 no. 2127-141
7. Institute of Medicine, Crossing the Quality Chasm: A New Health System for the Twenty-first Century (Washington: National Academies Press, 2001).
8. Jordan Rau - KHN Staff Writer, NOV 14, 2013 : http://www.kaiserhealthnews.org/stories/2013/november/14/value-based-purchasing-medicare.aspx
9. Kaiser Family Foundation:
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Are the health care providers at your facility being paid for service or on the basis of outcome as per PPACA?
To know if the legislation has been implemented or not
Q2. How effective has pay for performance programs proved for your facility overall?
To get a general idea about the stakeholder’s perception towards the new payment system as mandated by PPACA
Q3. What changes are made at your facility to make it more adaptable to new payment system proposed under PPACA?
To understand the costing and flexibility of facilities towards payments as per PPACA standards.
Q4. Have you noticed any other improvements at your facility in order to meet quality measures such as being more clearer with discharge instructions, follow up calls with the patients to decrease the readmission rates, doctor trainings to enhance doctor-patient communications etc.
To understand the strategies being adopted in various healthcare facilities in order to improve their scores on quality measures and if these strategies have proved helpful in improving the over quality of care.
Q5. Are the incentive amounts enough to cover the cost of change?
To analyze the cost effectiveness of the
Healthcare in the U.S. has recently been affected by implementation of the Affordable Care Act (ACA) of 2010. The intent is to create a healthca...
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Berwick, D. M. (2002). A user's manual for the IOM's 'quality chasm' report. Health Affairs,
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An electronic system, new form of payment that benefits society as a whole through Smart Cards. It creates less necessity to have physical cash and it holds the capacity and usage of the same cards ...
William, R. (2009, August). Improving quality and value in the u.s. health care system. Retrieved from http://www.brookings.edu/research/reports/2009/08/21-bpc-qualityreport
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Lighter, Donald and Douglas Fair. Principles and Methods of Quality Management in Healthcare. Gaithersburg MD: Aspen Publishing, 2000.