In December 2011, Texas Health and Human Services Commission (HHSC) received federal approval of a Medicaid Section 1115(a) Demonstration Waiver, entitled “Texas Healthcare Transformation and Quality Improvement Program,” for the period starting with December 12, 2011 through September 20, 2016. The main objective of the 1115 Waiver is to improve access to and quality of health care by expanding Medicaid managed care programs and promoting health care delivery system reforms while containing cost growth. Specifically, the Waiver created two new pools of funding—Uncompensated Care (UC) and Delivery System Redesign and Innovation Payment (DSRIP) pools—by redirecting funds that were available under the old Upper Payment Limit (UPL) payment methodology. DSRIP funding is used to offer financial incentives to health care providers that develop and implement projects aimed at improving how care is delivered to low-income populations. Specifically, the providers (often referred to as the “performing providers” or “performers”) propose and execute projects like programs, strategies, and investments designed to enhance access to health care, quality of health care, cost-effectiveness of services, and health of the patients and families served. Based on the completion of their project milestones, they receive DSRIP payments. Milestones are objectives of the projects, comprised of metrics indicating their progress, and the providers must achieve the milestones in order to claim the associated incentive funds. DSRIP projects are spanned over five demonstration years, DY1 through DY5. And each demonstration year has separate project milestones, metrics, and incentive funds. If providers fail to fulfill certain milestones, the fund... ... middle of paper ... ...h outcome domain, and the providers choose the ones they want to focus on that will best reflect the success of their projects. For each of these DSRIP activities, providers must also select suitable milestone and metric options from the DSRIP menu. In addition to receiving payments for completing milestones associated with Category 1 and 2 projects, providers receive separate incentive payments for completing milestones associated with Category 3. Category 4 requires all hospital-based providers to use the same reporting measures. For example, providers must report data related to potentially preventable admissions, readmissions and complications, patient-centered health care and emergency department utilization. Hospitals that are exempt from the Category 4 requirements pursuant to PFM Protocol Sections 11.e. and 11.f do not have to report on these measures.
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).
According to the Encyclopedia of Education, the program was first started in 1690. It became a way to deal with criminal court cases involving child abuse. Two years later the states and municipalities identified care for abused and neglected children as the responsibility of local government and private institutions. It was not until 1825, that the states enacted laws that gave social workers the right to remove children that had been neglected from their parents and their homes. The program has had several names since then. In 1835, it was the National Federation of Child Rescue, later in 1853; they founded the Children’s Aid Society which was a response to the problem of orphaned and abandoned children. In 1874, the “case of Mary Ellen” became the first child abuse case to be criminally prosecuted. In 1930, the Social Security addressed issues of abuse and neglect, which provided funding for intervention for “neglected and dependent children in danger of becoming delinquent.” Effective February 1, 2004, the name of the Texas Department of Protective and Regulatory Services was changed to the Texas Department of Family and Protective Services (Guthrie, Heyneman & Braxton, 2002). The Texas Department of Family and Protective Services, is a state agency that is run by the state government.
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.
(W. Lease, personal communication, July 23, 2010), the “unknown” of the recent health care reform legislation is an external influence that is most relevant to our organization, stated by William Lease, senior vice president of clinical support services. Mr. Lease states, that health care reform legislation will impact our organization in many ways; especially after 2014. While more employees will have health insurance coverage and there will be more patients to treat; the need for controlling costs and improving efficiency is i...
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.
A very notable goal is to make healthcare affordable for all Americans and at the same, improving the quality and efficiency in which healthcare is conducted. Many look at this act and notice the key benefits that are provided for all Americans, and are interested to find other improvements that help everyday ...
As I began watching Reinventing Healthcare-A Fred Friendly Seminar (2008), I thought to myself, “man, things have changed since 2008.” And as the discussion progressed, I started to become irritated by how little had changed. The issues discussed were far-reaching, and the necessity for urgent change was a repeated theme. And yet, eight years later, health care has made changes, but many of its crucial problems still exist.
The author also believes that the Medicaid expansion extends beyond the politics, and has an aim to impact the life, health, and financial stability for the state and individuals. Medicaid expansion can be beneficial to many countries that have a large proportion of low-income people that are uninsured and or with disabilities. This can aid in saving the state money because much of the cost is provided and covered by the federal government, that encourages healthier behavior and results to a reduction in chronic disease due to lower health care costs. Although Texas opted out in adopting the expansion, legislators should decide on the advantage and disadvantage of participating in the Medicaid expansion to improve the welfare of the state. The expansion of Medicaid coverage will give low-income pregnant women the chance to reduce the rate in infant mortality and provide an opportunity for those that were unable to get coverage to be
Medicaid is a broken system that is largely failing to serve its beneficiary’s needs. Despite its chronic failures to deliver quality health care, Medicaid is seemingly running up a gigantic tab for tax payers (Frogue, 2003). Medicaid’s budget woes are secondary to its insignificant structure, leaving its beneficiaries with limited choices, when arranging for their own health care. Instead, regulations are set in order to drive costs down; instead of allowing Medicaid beneficiaries free rein to choose whom they will seek care from (Frogue, 2003)
Legislators have worked to bring comprehensive change to the United States health care system. The primary target population was the over 50 million of uninsured Americans. Helped by the healthcare reform there is now an additional surge of new users that
On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (PPACA), a piece of legislation that seeks to improve the American health care landscape in a variety of ways. The PPACA strives to increase access to affordable insurance coverage while working towards structural and other changes that will keep future healthcare costs under control. The common goal, and the one concept that is unanimously accepted is the aspiration to improve the quality of care for all citizens across the United States at the highest of standards.
The federal and state governments are trying to find a way to managed their Medicaid by reducing costs and improving the amount of quality the Medicaid provides. Both federal and state governments are trying to eliminate unnecessary services and rely more on their primary care and the coordination of care. sta...
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.
Reforming the health care delivery system to progress the quality and value of care is indispensable to addressing the ever-increasing costs, poor quality, and increasing numbers of Americans without health insurance coverage. What is more, reforms should improve access to the right care at the right time in the right setting. They should keep people healthy and prevent common, preventable impediments of illnesses to the greatest extent possible. Thoughtfully assembled reforms would support greater access to health-improving care, in contrast to the current system, which encourages more tests, procedures, and treatments that are either
Since a significant part of the population is young females, there is a need for services regarding gynecology, family, and pediatric care (Taylor, 2004). Despite most of the population being young, diabetes and hypertension also play a role in the population and therefore, services are needed to address these issues (Taylor, 2004). Since most of health care center populations are from low income households, health care centers usually provide enabling services such as “case management, translation, transportation, outreach, eligibility assistance, and health education” as well as other comprehensive services (Taylor, 2004, p. 8). To assure health care centers are fulfilling its purposes, each health care center goes through a Performance Review Protocol where the health care center is graded more on their performance than its compliance, unlike its former Primary Care Effectiveness Review (Taylor,