Cost Patients: Pay-For-Performance Analysis

Some of these extended stays in the hospital are not to provide the quality of care that the patients need nor the seriousness of the sickness. It is to claim for income since that is how hospitals get more pay from the insurance companies. And that is because most insurance companies and Medicaid focus on paying per day services instead of the itemized used and the quality of care provided. These only benefit the hospitals. It doesn 't bring any benefit to the insurance companies nor the patients. Rather some patients get more infections from staying long in the hospital which creates another high cost and health risks. Putting a stop to price inflation each year for physicians is a "painless cost control." In my opinion, price inflation for doctors should only take place when there is general inflation in the

As an integral part of the healthcare team, nursing has evolved tremendously. In Nurse of the Future Nursing Core Competencies a picture was painted of what the future of nursing looks like. From my own opinion I do feel that a reform or evolution in nursing education is required to create competent nurses of the future. Current nursing school programs are academic heavy with an emphasis on skills. While growing competency in clinical skills is necessary, there is much more to the future of nursing than being highly skilled. It is time to distinguish not just skills, but characteristics of a successful nurse of the future. This is a nurse who will be well rounded with the tools and resources to help guide healthcare and the patient experience

Your discussion presents an interesting perspective on business principles. Managing financial needs of a hospital and patient’s satisfaction goes hand and hand in the hospital field. This also can create a negative impact when it comes to prescribing pain medication. An ethical dilemma arises for emergency room providers who in relation to new reimbursement tactics centered upon patient satisfaction scores (Kelly, Johnson, & Harbison, 2016) I feel that these doctors are feeling pressure to prescribe pain medications in order to increase patients scores and in return improve reimbursement for their units. This is contributing to the increase of opioid abuse that is already prevalent in this nation. This needs to be taken into consideration

When being placed in the role of a manager, it is important to understand the finances of the organization and how to read and understand the recording of finances. It is also important to understand how all the different parts of the records fit together to give us the knowledge of where the business is financially. Knowing also the different responsibility centers related to financial recording and how they function is important as a manager. Once a manager understands what and where items belong on a balance sheet, they will better understand the state that the business is in. “It provides you with a picture of the financial health of your practice or organization on a certain date.” (Arnow & Xakellis, 2001).

Although the US is technologically advanced and has some of the highest caliber medical professionals in the world, compared to many other industrialized countries, it has one of the lowest outcomes in regards to quality of care. Moreover, it has some of the highest overall medical costs (Panning, 2014). In the US, low quality care and high costs have resulted in fragmentation of the healthcare delivery system. Fragmentation of services often results in patient experiences that are poor, with less than desired clinical

“In my opinion, our health care system has failed when a doctor fails to treat an illness that is treatable” (Kevin Alan Lee 2011). Being a doctor is mean to cure diseases unconditionally. However, the healthcare system in the United States today has always been the top concern in every family and individual. As compared to most of other countries, their governments provide free health care to their citizens at any time (Sicko). We as one of the most powerful countries seems far left behind that people are still suffering from high medical expenses and are still fighting over a basic need of being covered with free health care. As taxpayers in the United States, we should be covered with free healthcare unconditionally and completely because everyone needs to be healthy for a

Prior to the implementation of the Affordable Care Act (ACA), few people anticipated employer-provided health care would disappear as a major player in the United State healthcare arena. However, ACA adoption and has put more than 169 million employees at risk for losing their workplace coverage. Several studies indicate employer-based coverage will decline rapidly over the next decade as the traditional US system is displaced by the healthcare exchange system. While consumers grapple with finding affordable coverage options and providers adjust to the new norms, there is another wrinkle in the mix. In January, Health and Human Services (HHS) Secretary Sylvia M. Burwell announced the agency's push toward value-based and alternative reimbursement models. HHS expects 90% of Medicare payments to be directly tied to quality measures by 2018. It is imperative that hospitals, urgent care clinics and frontline providers align their

Healthcare is made up of many factors. Among those factors are provider reimbursement and the different types of financial methods used by the patients to acquire healthcare services. Provider reimbursement is important and necessary in order to maintain the continuation of healthcare. Like every organization, including non-profit organizations, require revenue in order to pay their healthcare providers, expenses accrued, and to obtain the supplies needed to aid in rendering services. With that said, this is why there are many financial methods such as third-party payers, government agencies, private health insurance, and patient payments. These methods include many financing agencies that are utilized by individuals

Since CMS implemented the Physician Quality Reporting Initiative (now known as the Physician Quality Reporting System (PQRS) under the Tax Relief and Health Care Act of 2006 (TRHCA), there have been several changes in participation sanctions, reporting mechanisms and eligibility for incentives and bonuses. During the first two years, the program was technically a temporary, renewable initiative that sought to improve the quality of both delivery and coordination of care. The initiative became permanent when the Medicare Improvement for Patients and Providers Act (MIPPA, 2008) was enacted.

treat. ACO’ us the “fee for services” having the goal of providing care for patients yet avoiding

The Affordable Care Act consists of the ten sections including Quality, Affordable Health Care for all Americans, Role of Public Programs, Improving the Quality and Efficiency of Health Care, Prevention of Chronic Disease and Improving Public Health, Health Care Workforce, Transparency and Program Integrity, Improving Access to Innovative Medical Therapies, CLASS Act, Revenue Provisions, and Strengthening Quality, Affordable Health Care for all Americans (Fontenot, 2013). The Affordable Care Act aims to reduced the number of uninsured Americans by mandating all citizens have health insurance either through private insurance coverage or increasing access to public insurance coverage. The reduction of uninsured in theory should reduce the cost of healthcare. Prior to The Affordable Care Act, the burden of cost associated with the uninsured was shifted to the physicians, hospitals, and consumers. HHCAPS or value-based reimbursement should improve the quality and efficiency of healthcare. Healthcare providers who fail to demonstrate improvement in quality and efficiency will be penalized by two percent for each reporting year that they do not comply with the standard of care and quality standards imposed by CMS. Failure to pay for healthcare acquired conditions will also demonstrate a

First, the ACA has brought about considerable improvements in access to affordable health insurance in the United States. On the basis of their own reports, newly insured Americans are also able to see physicians within reasonable periods of time, and anecdotal reports about restricted access to out-of-network providers, although a concern, have not yet caused a major backlash. Second, the implementation of the ACA has coincided with another important development — a slowdown in the rate of increase in national health care spending. From 2010 through 2013, per capita U.S. health care expenditures increased at the historically low rate of 3.2% annually, as compared with 5.6% annually over the previous 10 years. As a percentage of the gross domestic product, health spending has stabilized at approximately 17%. Third, if it is premature to draw conclusions about the cost effects of the ACA, it is doubly so for the quality effects of the law. The reductions in hospital-acquired conditions and Medicare readmissions since the enactment of the ACA are unprecedented and encouraging, but here again, the causes of these favorable trends are uncertain. It may be some time before we can assess the quality effects of this major new legislation.

In the film Escape Fire the Fight to Rescue American Healthcare, there were many insightful examples of why our Unites States healthcare revolves around paying more and getting less. The system is designed to treat diseases rather than preventing them and promoting wellness. In our healthcare industry, there are many different contributors that provide and make up our system. These intermediaries include suppliers, manufacturers, consumers, patients, providers, policy and regulations. All these members have a key role in the functionality of the health care industry; however, each role has its positives and negatives. Each person with an occupation in the healthcare industry is doing their designated job as assigned, but it’s evident that the system’s design is flawed to its core.

There are several consequences of a profit-driven health care system, whether it was intended or unintended. The intended consequence would be scientists and researchers working to make profits instead of working to help people. Besides, profit-driven health care system can lead to unequal access to medication. On the other hand, the unintended consequence would be “…patients blocking the progress of science by holding out for excessive profits” (Skloot, 2010, p. 147)

As the healthcare landscape continues to shift, medical providers and hospitals are continuously being challenged to develop clear and concise visions and redesign care delivery in ways that will usher proper transitions to value-based care. As value-based healthcare continues to take root, more and more hospitals and providers are finding themselves with little option but to join the movement. However, the jump from previously utilized fee-for-service models to value-based healthcare is not an easy one, and many healthcare organizations are finding it difficult to do so. The greatest challenge lies in successfully making the transition from volume to value-based healthcare in ways that are financially stable. Such inherent difficulties faced by those within the healthcare system are what have necessitated strategic