Bundled Efficiency
In the U.S. alone, more than 366,000 people diagnosed with end stage renal disease (ESRD) are dependent on kidney dialysis as their life sustaining therapy (Collins, Foley, Gilbertson, & Chen, 2009). The majority of these patients rely on costly in-center hemodialysis (HD) three times a week to filter their blood during four-hour sessions. Since 1972, Medicare had covered patients’ dialysis related costs along with the separately billed and frequently used medications that are part of the end stage kidney disease treatments. The yearly price of this coverage had unveiled the shocking price tag of $77,506 for each individual requiring chronic hemodialysis care (Iglehart, 2011). In the government’s effort to constrain the escalating cost of dialysis treatments, the new bundling guidelines came into effect as of January 1st, 2011.
Organization’s Description
Renal Care Partners is a small group of dialysis clinics with the headquarter office in Florida. Each clinic will have assumed different partnership with the physicians that are the shareholders of the clinic. Accordingly, each clinic can have unit specific policy and procedures that reflect the nephrologists’ involvement of the company’s financial situation. In general, a charitable donation as a company has been scarce. In the past, RCP has participated in the National Kidney Foundation’s Kidney Walk event. Few employees on an individual basis have volunteered their services and donated funds to raise awareness about chronic kidney disease. Furthermore, HR as the administrator has managed the clinic for the last eight years working closely with physicians of the Virginia Nephrology Group. She has managed the fourteen employees in the clinic whil...
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..., if the dialysis costs exceed that of the bundled rate, dialysis centers must absorb the exceeding cost. Accordingly, the dialysis clinics will be monitored by a Quality Incentive Program (QIP). Clinical outcome measures relating to anemia management and dialysis adequacy will be evaluated against the clinic’s own past performance or national standards of dialysis. Starting in 2012, the clinic’s failure to meet QIP’s standards will generate penalty that can equate up to two percent of payment reductions (Iglehart, 2011). This demonstration of close vigilance by the CMS suggests its concerns for quality measurement in the midst of national healthcare budget crisis. In conclusion, dialysis clinics can successfully confront the financial constraint by modifying the business infrastructure to reflect clinical efficiency and expanding the home PD program.
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).
Ms. Bardsley functions as a hemodialysis liaison and leader in clinical practice with the following roles: charge nurse, preceptor, and mentor for her colleagues. She is the resource person for the Hct-Line monitoring tool. The tool is used to monitor patient’s fluid removal during treatment to avoid hypotensive episodes associated with decreased perfusion to the heart. She routinely monitors the patient outcomes which to date has resulted in 0 admissions. She recently updated the policy to make it more user friendly for the staff and to maintain staff competency.
The health care organization with which I am familiar and involved is Kaiser Permanente where I work as an Emergency Room Registered Nurse and later promoted to management. Kaiser Permanente was founded in 1945, is the nation’s largest not-for-profit health plan, serving 9.1 million members, with headquarters in Oakland, California. At Kaiser Permanente, physicians are responsible for medical decisions, continuously developing and refining medical practices to ensure that care is delivered in the most effective manner possible. Kaiser Permanente combines a nonprofit insurance plan with its own hospitals and clinics, is the kind of holistic health system that President Obama’s health care law encourages. It still operates in a half-dozen states from Maryland to Hawaii and is looking to expand...
Objective 1: Improve services in the region area where the nonprofit organization is located by 40% by the end of the year. The health services within the organization needs improvement. To evaluate, we will need to determine how much funding available to improve services and to order new medical equipment. Each facility administration will keep account of the number of medical equipment supplies over the course of each year. Each facility will need to be addressed and examined to see what the needs are in each facility. To measure improve services, we will have surveys to give to the patients and families to ask how they feel bout new current healthcare services. The improve services will have better hands on medical help and quality and efficient medical technology equipment. Data will be
Margaret E. O’Kane is the founder and president of the National Committee for Quality Assurance (NCQA). NCQA is one of the nation’s leading advocates for improving healthcare through measurement, reporting, and accountability. NCQA is the foremost accrediting organization for health plans including HMOs, PPOs, and consumer directed plans. (Margaret) “Our goal is to increase the value of NCQA accreditation both to organizations pursuing accreditation and to the audiences who seek help in assessing the quality of health care provided by those organizations”. NCQA has developed, maintained, and expanded the nation’s most widely used health care quality tool, which is known as the Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS is responsible for evaluating whether and how well
In Medicare's traditional fee-for-service payment system, doctors and hospitals generally are paid for each test and procedure. This drives up costs by rewarding providers for doing more, even when it’s not needed. ACOs continue to utilize fee for service by creating incentives to be more efficient by offering bonuses when providers keep ...
Pay-for-performance (P4P) is the compensation representation that compensates healthcare contributors for accomplishing pre-authorized objectives for the delivery of quality health care assistance by economic incentives. P4P is increasingly put into practice in the healthcare structure to support quality enhancements in healthcare systems. Thus, pay-for-performance can be seen as a means of attaching financial incentives to the main objectives of clinical care. However, reimbursement is a managed care payment by a third party to a beneficiary, hospital or other health care providers for services rendered to an insured or beneficiary. This paper discusses how reimbursement can be affected by the pay-for-performance approach and how system cost reductions impact the quality and efficiency of healthcare. In addition, it also addresses how pay-for-performance affects different healthcare providers and their customers. Finally, there will also be a discussion on the effects pay-for-performance will have on the future of healthcare.
...lthcare system is slowly shifting from volume to value based care for quality purposes. By allowing physicians to receive payments on value over volume, patients receive quality of care and overall healthcare costs are lowered. The patients’ healthcare experience will be measured in terms of quality instead of how many appointments a physician has. Also, Medicare and Medicaid reimbursements are prompting hospitals, physicians and other healthcare organizations to make the value shifts. In response to the evolving healthcare cost, ways to reduce health care cost will be examined. When we lead towards a patient centered system organized around what patients need, everyone has better outcomes. The patient is involved in their healthcare choices and more driven in the health care arena. A value based approach can help significantly in achieving patient-centered care.
...s will need to focus on pay-for-performance initiatives, as CMS will reduce annual payments by 0.4 percent if the ten quality measures are not submitted (Buchbinder & Shanks (2007). The next generation of health care administrators will be judged on these competencies as they continue to develop into experienced health care administrators.
The balance between quality patient care and medical necessity is a top priority and the main concern of many of the healthcare organizations today. Due to the rising cost of healthcare, there has been a change in the focus of reimbursement strategies that are affecting the delivery of patient care. This shift from a fee-for-service towards a value-based system creates a challenge that has shifted many providers’ focus more directly on their revenue. As a result, organizations are forced to take a hard look at the cost of services they are providing patients and then determining if the services and level of care are appropriate for the prescribed patient care.
Traditional hemodialysis (HD) is provided to the patient at an outpatient clinic that is often referred to as a chronic unit. Patients must come to the chronic unit to be hooked up to the dialysis machine which circulates their blood through a dialyzer thereby removing toxins and excess fluid. This dialyzer is a clear plastic tube which contains thousands of micro fibers that allow the blood to flow through while enabling diffusion to remove the unwanted components of the blood. The majority of dialysis patients use this as their primary method of treatment; however, some patients find the treatment to be harsh and uncomfortable. These patients often look for alternate treatments such as peritoneal dialysis.
When dealing with health care financial management plays a key part of health care financial planning. Several of the financial decisions are made on a daily basis from accounting and all other business transactions that occur. Most of the decisions that are made are made, according to the organizations fiscal objectives, although some are made on the generally accepted accounting principles. Keeping accurate financial records keeps the organizations free from audits and mismanagement of funds.
On these occasions, I rely on my nursing assessment, evaluation, and interventions, collaborative skills, and scientific knowledge to make sound clinical judgments for the benefit of my patients. As a hemodialysis nurse, I will persevere to comply with innovation in nursing practice, EBP, research, and education. I believe growth requires generation of innovative, improved ideas and practices for the betterment of the organization and patient satisfaction. For this reason, I will embrace technological advancements; empower front line staff to embrace change and innovation; and motivate staff to be change agents on the floor with the aim to provide better quality of care for our
...d procedures are now being monitored to improve clinical processes. Ensuring that these processes are implemented in a timely, effective manner can also improve the quality of care given to patients. Management of the processes ensures accountability of the effectiveness of care, which, as mentioned earlier, improves outcomes. Lastly, providing reimbursements based on the quality of care and not the quantity also decreases the “wasting” and overuse of supplies. Providers previously felt the need to do more than necessary to meet a certain quota based on a quantity of supplies or other interventions used. Changing this goal can significantly decrease the cost of care due to using on the supplies necessary to provide effective, high-quality care. I look forward to this implementation of change and hope to see others encouraging an increase in high-quality healthcare.
Nguyen, N. (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