Abstract The author will choose for the purpose of this deliverable three-accreditation program that could replace the joint commission. This author will compare these agencies to the condition of participation for Medicare and Medicaid services. Then will analyze the cost and benefits of each and their impact on stakeholder groups and rank them according to the author’s rationale. Accreditation Association for Ambulatory Health Care (AAAHC) The Accreditation Association for Ambulatory Health Care was founded in 1979 and accredits ambulatory health care performed in ambulatory surgery centers, office-based surgery centers, and college health centers. The AAAHC has trusted status by the center for Medicare and Medicaid services and is one out …show more content…
Although special permission to determine compliance has been granted Medicare still reserves the right to survey an ASC after it is open. ACHC and Medicare COP CMS has established provider requirements for home health agencies, hospices, durable medical equipment, prosthetics, orthotics, and supplies that participate in the Medicare program. Therefore, Medicare requires organizations are accredited and approved by an accrediting agency such as ACHC before Medicare will approve them for participation. AAAASF and Medicare COP AAAASF offers three programs to become accredited that are CMS approved. The three programs are surgical (ASC), physical therapy, and rural health clinics. Facilities that have been Medicare certified may apply for the AAAASF accreditation. After AAASF accreditation is granted the state will not review prior to, but can and may conduct an inspection of their own. These inspections are separate from Medicare and exceed physical environment requirements by CMS. Cost and Benefits of AAAHC for stakeholder groups Benefits for patients under the AAAHC are being treated with respect, consideration and …show more content…
Additional AAAHC benefits for patients are the assurance of receiving the highest achievable level of care for recipients in the most efficient and economically sound manner. There are really no costs, just benefits for patients. Benefits for providers are having health care experts to develop, review and revise standards, and tools to support continuous quality improvement. In addition to providing better quality care, being appealing to patients, participating in the Medicare program for facility fee reimbursement and fulfilling requirement of third party payers. As for provider costs under AAAHC, “conversely, it is true that a facility can provide excellent care without accreditation and there are associated costs. The standards are extensive and it will require considerable time to gather necessary documentation, track data that are required, and to prepare for the actual survey” (Harmer,
Membership Services (MSD) at Kaiser Permanente used to be a modest department of sixty staff. However, over the past few years the department has doubled in size, creating minor departmental reorganization. In addition the increase of departmental staffing, several challenges became apparent. The changes included primary job function, as well as the introduction of new network system software which slowed down the processes of other departments. These departments included Claims (who pay the bills for service providers outside of the Kaiser Permanente network), and Patient Business Services (who send invoices to members for services received within Kaiser Permanente). Due to the unforeseen challenges created by the system upgrade, it was decided that MSD would process the calls for both of the affected departments. Unfortunately, this created a catastrophic event of MSD receiving numerous phone calls from upset members—who had received bills a year after the service had been provided. The average Monday call volume had risen from 1,800 to 2,600 calls per day. The average handling time for each phone call had risen as well—from an acceptable standard of 5.6 minutes to an unfavorable 7.2 minutes. The department continued to be kept inundated with these types of calls for the two years that these changes have been effect.
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).
State and federal regulations, national accreditation standards, and clinical practice standards are created, and updated regularly. In addition, to these regulations, OIG publishes a compliance work plan annually that focuses on protecting the integrity of the program, and prevention of fraud and abuse. The Office of the Inspector General examines quality‐of‐care issues in nursing facilities, organizations, community‐based settings and occurrences in which the programs may have been billed for medically unnecessary services. The Office of the Inspector General’s work plan for the fiscal year 2011 highlights five areas of investigation for acute care hospitals. Reliability of hospital-reported quality measure data, hospital readmissions, hospital admissions with conditions
Along the same lines as the capability gap for bundled payment models, ACOs are experiencing a similar need. CMS reported the financial results for more than 300 ACOs in August of 2015, and together, the ACOs generated savings of over $400 million. Despite these aggregate savings, more than 40% of those ACOs increased spend relative to their baseline expenditure. (Source: CMS, Medtronic analysis) As a result, there is significant opportunity for Medtronic to leverage the breadth of its product line and VBHC capabilities to play a role in bridging care settings and connecting disparate care teams in order to improve outcomes and lower costs over a longer time
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
Merwin, E & Thornlow, D. (2009). Managing to improve quality: the relationship between accreditation standards, safety practices, and patient outcomes. Health Care Managment Review, 34(3), 262-272. DOI: 10.1097/HMR.0b013e3181a16bce
To gain accreditation, TJC sets rigorous safety and quality of care standards and evaluates organizations to see whether or not they meet their standards. After the survey, TJC provid...
Conditions of Participation was created to ensure all facilities participating in Medicare follow a set of regulations that protect the safety of Medicare recipients. In 1986 revisions were made to reinforce accreditation and certification procedures. Participating hospitals that are accredited by the Joint Commission on Accreditation of Healthcare Organizations or American Osteopathic Association have been deemed to meeting Conditions of Participation requirements on the wellbeing of Medicare Recipients. The Joint Commission on Accreditation of Healthcare Organizations also requires that the facilities are licensed by their state. (Lohr, 1990, p.
Given the fact that one-third of all healthcare expenditures is for ambulatory care, it is safe to say that patients spend most of their time in an ambulatory care setting (Carper, 2013). This setting has a significant impact in the overall assessment of the healthcare industry and how care is delivered. It is important to address data collected by surveys to implement strategies for quality improvement. Affecting care in Ambulatory settings will have the largest significance in the health outlook.
Medicare is the nation’s largest health insurance program. Generally, you are eligible for Medicare if you or your spouse worked for at least ten years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. Medicare-covered services include hospital insurance, inpatient hospital care, skilled nursing facility care, home health care, hospice care, and medical insurance (Medicare U.S.) With such an encompassing effect on the health insurance field, Medicare provides a haven for older individuals, and end-stage renal disease (ESRD) patients who require the best medical care for whatever possible reason. The only problem with this scenario is that doctors are turning many older patients away because they have Medicare. Why do doctors turn away Medicare patients? Is there a reason why certain doctors turn away certain patients?
... 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).
Blum,J.,(2011). Improving quality, lowering cost: The role of health care delivery system: U. S Department of health and human services.
Healthcare organizations are designed to meet the healthcare needs of individuals and promote a healthy community. The three healthcare organizations that interest me are: The Heart Hospital Baylor of Plano, Texas Health Center for Diagnostics & Surgery Plan, and Parkland Health and Hospital System. Due to evolving healthcare industry, focusing on just patients and physicians is no longer a marketing strategy. According to Mycek (2015), “Marketing teams need to expand their consideration set and focus on the new 5 P’s of Healthcare Marketing” (p. 1). The new 5 P’s of marketing now impact the marketing potential of healthcare organizations by offering changes in sales rep – physician access, purchasing, formulary decision making, and growing patient empowerment. The new 5 P’s of marketing are: Physicians, Patients, Payers, Public, and The Presence of Politics.
In conclusion the triple aim to improve the U.S. health care system in a managed way by simultaneously bringing three factors together. By providing quality care and reducing per capita the preconditions are competitive and accountable. With the five components the coordination of the mission goes beyond the financial incentives to providing evidence-based care with a focus on
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission. Retrieved March 19, 2005 from http://www.urac.org/