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...
Berwick, D. M. (2002). A user's manual for the IOM's 'quality chasm' report. Health Affairs,
... is an abstract model that proposes an exploratory plan for health services and evaluating quality of health care. In accordance with the model, information about quality of care can be obtained from three categories: structure, process, and outcomes. In addition, not long ago The Joint Commission include outcomes in its accreditation valuations (Sultz, & Young, 2011, p. 378).
In the healthcare system, quality is a major driving compartment for patient outcomes. The quality of care reflects the outcomes in a patient’s care. According to Feeley, Fly, Walters and Burke (2010), “quality equ...
THE NCQA health plan accreditation encompasses healthcare facilities to have written plan approved by the governing board and is required to be reviewed and updated periodically as if it was a policy or procedure document. Every department must have its own plan but not in any particular format. The plan must exhibit the essential aspects of the quality management system. This reading entails an example of a facility quality management plan. The board of trustees is responsible for the safety and quality care, treatment and services provided in the hospital. The board makes decisions with the medical staff and hospital management which include medical director, chief executive officer, nursing director, clinical services director, vice president
As a result, the institute published a classic report titled “Crossing the Quality Chasm” that still influences current thinking among health care decision makers. In fact, medial expert continue to publish “Crossing the Quality Chasm” reports as needed, with publication issued in 2003, twice in 2008, and 2011. It is with these reports that the IOM encourages utilization of the latest evidenced based practices while providing feedback about what patient desire.
improving the quality of care, it is important to begin by defining quality. Quality is purposed by
It is noted that to streamline operations and improve clinical outcomes successfully, you require a strong organizational structure and commitment, culture change, work flow processes and continuous staff education – what Health Catalyst refers to as an 'adoption system'. Our facility has embarked on this improvement journey and have assessed its readiness for change. Some examples of the criteria we have evaluated in assessing our readiness for change include, our shared vision, clinical leadership readiness, administrative support (such as outcome analyst availability, data manager) and data
In week 5, I will discuss what prospective payment system (PPS) is and the history. I will also be discussing the challenges and success areas of PPS. I will be using my own life example to explain how PPS might work in real life. In my conclusion, I will be going over what I discovered, the history of PPS and the challenges and success areas.
Lighter, Donald and Douglas Fair. Principles and Methods of Quality Management in Healthcare. Gaithersburg MD: Aspen Publishing, 2000.
The goal of quality improvement (QI) is to improve patient care, processes, outcomes, and manage risk. Ethical consideration to be addressed in accordance with this QI project involve protection of human rights, beneficence, and justice.
Once defined as “the degree of conformity with preset standards”...the standards of which care were judged was implicit and existed solely in the mind of evaluators (Sultz & Young, 2014). Quality of care is a measureable aspect of healthcare though challenging, it can classify and enumerate poor and high-quality care. Measures are used to analyze how healthcare institutions perform in quality and in finance; the organization has a basis for understanding its delivery of care and for improving that care (Dlugacz, 2006). The various departments and ranges of data needed to measure quality all differ in hospital settings but, the availability of medical records and other clinical information make it easier to evaluate quality of care. This paper will analyze the components of the quality of health care, identify agencies that focus on quality, explore the HCAHPS survey and the Center for Medicare & Medicaid Services roles in assessment of quality of care in hospitals.
From gathering medical data in patient charts to presenting statistical data analysis to C-level leadership, I have demonstrated effective and thorough best practice. The analyst position has broadened my interpersonal skills and problem-solving abilities, both of which are critical in any industry. I have been lucky to have the opportunity to present opportunities for improvement to leadership and participate in improving hospital practices that result in better patient outcomes. As CMS and The Joint Commission release new quality measures that get reported to the public, it is imperative for hospital systems to improve practices internally which in turn result in higher quality care. During my time at the hospital, I have significantly improved many quality measures by: building effective working relationships, continuing to learn on the job and challenging myself, all of which I believe will enable me to be successful in any area I
There many methods to get feedbacks to help quality care improvement. One way is to use patient’s survey, it can be done by mailing questionnaires, over the phone interview and in person. Another way is listening post, it is very important to get tune to what the patient or customer is communicating. Listening post strategies includes focus groups, Walkthroughs, complaint/compliment letters & patient and family advisor y councils. Survey is a good way to get feedback from patient to improve the quality of care; however, there is always questions that rise on the validity, reliability, readability, response rates and survey bias. percentage of bias, readable and the response rate should be in consideration. These questions have been creating people resistance, data resistance and other reason not to take the survey or listening log as a quality improvement. “Executives, senior
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 ...