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.
Kidney Care is comprised of U.S. dialysis and related lab services, ancillary services and strategic initiatives, including international operations and corporate administrative support. The U.S. dialysis and related lab services business is the largest line of business, which is a leading provider of kidney dialysis services in the U.S. for patients suffering from chronic kidney failure, also known as end stage renal disease (ESRD). The HCP division is a patient- and physician-focused integrated healthcare delivery and management company with over two decades of providing coordinated, outcomes-based medical care in a cost-effective manner ("DaVita Healthcare Partners 10-K Annual Report" 2015). STp(c) Segmentation, targeting, and positioning together comprise a three stage process.
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.
The CareGroup Case Study comprises various components. The core concepts were broken down into the history of CareGroup itself, CareGroup’s IT, the collapse of the network, dealing with the collapse of the network, and the lessons learned from the entire situation (McFarlan, F. Warren, and Robert D. Austin, pg.1). CareGroup was formed on the basis of three major Massachusetts hospitals; Beth Israel, Deaconess, and Mount Auburn (McFarlan, F. Warren, and Robert D. Austin, pg.1). After a surprising merger of Mass General and Brigham and Women’s Hospital, all three hospitals in CareGroup suffered great financial losses (McFarlan, F. Warren, and Robert D. Austin, pg.2). Due to the multi-million dollar financial losses, CareGroup felt they needed a change, which is when they added Halamka to their team, naming him their CIO (McFarlan, F. Warren, and Robert D. Austin, pg.3).
The patients should receive safe and appropriate care in return for payment equal to the level of care received (“What is Value-Based Care”, 2016). For providers, this means using affordable and proven treatments while also catering to the patient’s needs (“What is Value-Based Care”, 2016). Additionally, this model is built upon measurement which when relayed to the patient will inform them of the scope and cost of their care. Examples of measures that are tracked, provided by the article “What is Value-Based Care,” include: procedural complications, hospital-acquired infections, and readmissions; providers face penalties if these metrics are unacceptable (“What is Value-Based Care”,
Yong, Pierre L., Robert Samuel Saunders, and LeighAnne Olsen. The Healthcare Imperative: Lowering Costs and Improving Outcomes : Workshop Series Summary. Washington, D.C.: National Academies, 2010. Print.
It is very important that we utilize cost control methods in the health care field. The reason being is that about 10% of the population, usually with chronic to severe problems, use approximately 70% of the total spending (Shi, & Singh, 2008). If we didn’t monitor the costs and spending we wouldn’t be using the money efficiently. To avoid potential problems we frequently use six different cost control methods to monitor what medical services are necessary, the most cost efficient way for these services to be provided, and keep an up to date chart of the patient’s condition to offer only treatment deemed necessary.
2. The twin problems of the health care industry as viewed by society are cost and access. First of all, the cost of getting health care is very high and it is getting higher each day. This has been mostly caused by the combination of high cost and an increase in quantity of services provided to the communities. The other problem involves access to health care. American enjoy limited or no access to health care. Many efforts have been done to reform this, but still but still many people are left without access to the care. These two problems are related due to the fact that if the health care industry gets to high off course people no longer will be able to have any access to it. The higher prices are, the lower access people have to it.
Quinan, P. (2007). Control and coping for individuals with end stage renal disease on hemodialysis: A position paper. CANNT Journal, 17(3), 77-84.
...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.
This article describes the choices for treatment: hemodialysis, peritoneal dialysis, and kidney transplantation. It gives the pros and cons of each. It also discusses diet and paying for treatment. It gives tips for working with your doctor, nurses, and others who make up your health care team. It provides a list of groups that offer information and services to kidney patients. It also lists magazines, books, and brochures that you can read for more information about treatment.
In 2015, the Centers for Medicaid and Medicare Services (CMS) released the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) which implements the final rule which offers financial incentives for Medicare clinicians to deliver high-quality patient centered care.5 Essentially, taking the time to learn the patient’s goals and treatment preferences allows for the patient to walk away from the medical treatment or service feeling understood and cared for by the provider.4 Thus, resulting in a better, more comprehensive plan of care. Policy makers are hopeful that the new incentive-based payment system will accelerate improvement efforts.
This paper’s brief intent is to identify the policies and procedures currently being developed at Midwest Hospital. It identifies how the company’s Management Committee was formed and how they problem solved and delegated responsibilities. This paper recognizes the hospital’s greatest attributes and their weakest link. Midwest Hospital hired Dr. Herb Davis to help facilitate the development and implementation of resolutions for each issue.
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.
...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.
Chronic Kidney Disease. Mayo Foundation for Medical Education and Research, 2014. Web. 20 May 2014.