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The purpose of quality initiatives is to promote safe, timely, effective, efficient, equitable patient centered care( DeNisco & Barker, 2013). The quality improvement evaluation is important in the health care industry to find out the best practice care and to provide high quality cost effective care to patients. The public and private agencies are the regulatory entities in the health care Industry which promote quality and safety in the delivery of health care. The major regulatory agencies are CMS, the Joint commission, and AHRQ (deNisco & Barker, 2013). The public agencies such as CMS have periodically made drastic changes to their reimbursement policies. In 2003, the CMS began the hospital quality initiative and Home Health quality Initiatives ( Denisco & Barker, 2013). The hospital quality initiative mainly focused on Acute Myocardial Infarction (AMI), heart failure ( HF), and pneumonia( PNE). The home health quality initiatives also focused on quality measures for individuals receiving home care services ( DeNisco & Barker, 2013). In 2001 about 3.5 million disabled and elderly Americans received care from 7,000 Medicare certified home health agencies and about 3 Million elderly and disabled Americans received care from 17,000 Medicare and Medicaid certified Nursing Homes ( DeNisco & Barker, 2013). In 2004, CMS Nursing home Quality Initiative started 14 quality measures in the areas of delirium, pain( acute and chronic), incontinence, decline in activities of daily living, physical restraints, worsening of anxiety and depression, pressure sores, indwelling catheters, mobility decline, bedfast, weight loss and urinary tract infections( DeNisco & Barker, 2013). The National... ... middle of paper ... ... References Blum,J.,(2011). Improving quality, lowering cost: The role of health care delivery system: U. S Department of health and human services. Retrieved from http://www.hhs.gov/asl/testify/2011/11/t20111110a.html DeNisco, S. M.,& Barker, A. M., (2013). Advanced practice nursing: Evolving Roles for the Transformation of the profession (2nd ed.). Boston: Jones & Barlet. Ruppert, S, D., Shiao, S, K., Tolentino-DelosReyes, A. F.,(2007). Evidence- Based Practice. Use of the Ventilator Bundle to prevent Ventilator associated pneumonia (3rd ed). American Journal of Critical Care. Pesah, S. K., McKay, N.,Harman, J. S., Amin, M., Cook, R. L (2013). Medicare nonpayment of Hospital- Acquired infection: Infection rates three post implementation. Centers for Medicare and Medicaid services.
With the passage of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) has initiated reimbursement based off of patient satisfaction scores (Murphy, 2014). In fact, “CMS plans to base 30% of hospitals ' scores under the value-based purchasing initiative on patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems survey, or HCAHPS, which measures patient satisfaction” (Daly, 2011, p. 30). Consequently, a hospital’s HCAHPS score could influence 1% of a Medicare’s hospital reimbursement, which could cost between $500,000 and $850,000, depending on the organization (Murphy, 2014).
Role clarity and title confusion pose barriers to the amalgamation of advanced practice nursing roles. Colleagues and the public are unaware of the precise roles of the APN. Much of what the public knows about medicine is associated with a doctor, and the “doctor knows best” (Safriet, 2011). The public i...
Under the Social Security Act, it is required that hospitals report quality measures for a set of 10 indicators. If hospitals do not report quality measures to CMS there is a reduction in payments. In the hospital readmission area of investigation, OIG reviews Medicare claims in hospital readmission cases to identify trends and oversights of cases. Readmissions are cases in which the beneficiary is readmitted to the hospital less than 31 days after being discharged from the hospital. Hospitals are only entitled to one diagnosed-related group payment if there is a same-day readmission for symptoms related to prior hospital stay. Quality improvement organizations are required to review hospital readmission cases also this is to see if standard of care are met. For coded conditions as present on admission, it is required for acute hospital to report these diagnoses on Medicare claims. The OIG will review Medicare claims for types of facility or providers most frequently transferring patients to hospital
Hospitals recognized the need for the case management model in the mid 1980’s to manage the lengths of stay of hospitalized patients and the treatment plans (Jacob & Cherry, 2007). In 1983, the Medicare prospective payment program was implemented which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007). To keep the costs below the diagnosis related payment, hospitals ...
Kovner, A.R & Knickman, J.R (2011) Jonas & Kovner’s Health Care Delivery in the United States, 10th Edition. New York: Springer Publishing.
Shi, L., & Singh, D. (2012). Delivering health care in America: a system approach. Burlington, MA: Jones & Bartlett Learning, LLC.
Mundinger, M., (1994). Advanced-Practice nursing—good medicine for physicians? New England Journal of Medicine, 33(3), 211-214. Retrieved from http://www.nejm.org/doi/pdf/10.1056/NEJM199401203300314
Many interventions are already in place to improve patient outcomes while on a ventilator. For example, elevating the head of the bed to 30 degrees, preventing venous thrombus via sequential compression devices or anticoagulant drugs, initiating early mobilization and practicing good hand hygiene were among the interventions listed by Fields, L.B., 2008. However, oral care was n...
Nursing homes who receive federal funds are required to comply with federal laws that specify that residents receive a high quality of care. In 1987 Congress responded to reports of widespread neglect and abuse in nursing homes during 1980’s, which enacted legislation to reform nursing home regulations and require nursing homes participating in the Medicare and Medicaid programs to comply with certain requirements for quality of care. The legislation, included in the Omnibus Budget Reconciliation Act of 1987, which specifies that a nursing home “must provide services and activities to attain or maintain the highest practicable phys...
...sa, H. Cashin, A. Buckley, T. Donoghue, J. (2014). Advancing advanced practice — clarifying the conceptual confusion. Nurse Education Today 34 (2014) pp. 356–361
This system provides annual statics on Medicare payment amounts for institutional providers. A nurse leader can use HCRIS to find other similar institutions with whom to compare reimbursement rates and use this information to make necessary adjustments (“Healthcare Cost Report”, 2016). Lastly, nurse leaders can also use cost-to-charge ratios, volume-based measures, per diem rates, and balanced scorecards to gain better insight of unit reimbursement (Liberty University,
In the United States, nearly one-fifth of patients discharged from the hospital are readmitted within thirty days, and most of those readmissions are considered to be preventable (Verhaegh et al., 2014). Many opportunities to reduce health care costs and prevent readmissions could save Medicare as much as $12 billion a year (Constantino, Frey, Hall & Painter, 2013). These numbers are significant from a financial standpoint, but do not consider the negative impact on the patient’s experience, the perception of poor care quality and inadequate transitional care. Hospital readmissions may be linked to ineffective discharge planning, lack of care coordination, lack of outpatient follow-up care, client’s non-compliance with treatment regimen, inadequate
The first key message that is discussed is that nurses should practice to the fullest extent of their education and training. Most of the nurses that are in practice are registered nurses. Advanced nurse practitioners are nurses that hold a master’s or doctoral degree and include nurse midwifes, clinical nurse specialists, nurse practitioners, and nurse anesthetists and consist of about two hundred and fifty thousand of the nurses currently working today. Advanced practice nurses are limited to what
Pneumonia can also become a hospital acquired infection. Ventilator-associated pneumonia is a type of lung infection that occurs in a person who has been on a ventilator.... ... middle of paper ... ...
Understanding quality measurement is essential in improving quality. Teams need to be able to understand whether the changes being made are actually leading to improved care and improved outcomes. For data to have an impact on an improvement initiative, providers and staff must understand it, trust it, and use it. Health care organization must understand the measurement of quality provided by the Institute of Medicine (patient outcomes, patient satisfaction, compliance, efficiency, safe, timely, patient centered, and equitable. An organization cannot improve its performance if it does not know how it is performing. Measuring quality improvements is essential as it reflects the quality of care given by the providers and that by comparing performance