Effect of Pay for Performance Model on Healthcare

Effect of Pay for Performance Model on Healthcare Priscilla Hernandez As the federal agency responsible for the Medicare program, the Centers for Medicare and Medicaid Services needed to ensure that beneficiaries received the highest quality care. The implementation of the pay for performance programs by the Centers for Medicare and Medicaid Services may have the source for improvement of the care delivered to Medicare patients. In 2006, a Health Law Review article defined pay for performance as â€Å"a reimbursement method under which some physicians and hospitals are paid more than others for the same services because they have been deemed to deliver better quality care and their patients appear to have better outcomes† (Mayes 17-22). Through these pay for performance programs, the Centers for Medicare and Medicaid Services would incentivize or penalize providers (e.g., hospitals, physicians, home health agencies) based on their performance on clinical, outcome and patient experience measures. For decades, the Centers for Medicare and Medicaid Services and other insurance payers have reimbursed providers using a fee-for-service payment model. The term fee- for-service is defined as â€Å"a method in which doctors and other healthcare providers paid for each service performed†¦.services include tests and office visits† (Healthcare.gov). In their 2011 Health Law Review article, the opinion of Mayes and Walradt was that the P4P program was â€Å"developed largely in response to the cost control problems and perverse incentives associated with fee-for service reimbursement, which is the dominant model in the US† (1). Throughout the last ten years, Congress has enacted legislation such as the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Deficit Reduction Act of 2005 and the Affordable Care Act of 2010, as a means of moving away from this fee-for-service model to a pay for reporting model and eventually to a pay for performance model (Frequently Asked Questions 8). The journey to ensure improved patient care began with the creation of the pay for reporting programs. The pay for reporting programs included the Hospital Quality Alliance, the Reporting Hospital Quality Data for Acute Payment Update later known as the Hospital Inpatient Quality Reporting Program and the Reporting Physician Quality Reporting System. The pay for performance programs included the Hospital Value Based Purchasing program, the Physician Value Modifier and the Accountable Care Organizations. The following paragraph will give a brief history of the transition of the pay for reporting program to the pay for performance program. In 2005, as a result of the Modernization Act of 2003, hospitals voluntarily submitted data on ten quality measures to avoid a 0.4 percentage points reduction in their annual payment update for fiscal years 2005, 2006 and 2007 (Hospital Quality Initiative 3). The quality measures focused on four conditions or diseases that were among the most common, most expensive to treat and most serious conditions for Medicare beneficiaries. These conditions were acute myocardial infarction, heart failure, pneumonia, and surgical care improvement (Hospital Quality Initiative 4). Between 2004 and 2007, the measures increased from ten to thirty-six. The signing of the Deficit Reduction Act of 2005 brought six additional measures and hospitals who did not voluntarily report were at risk of a 2.0 percentage point reduction to their annual payment update for fiscal y ear 2009. The 2009 Centers for Medicare and Medicaid Services paper, â€Å"Roadmap for Implementing Value-driven Health Care in the Traditional Medicare Fee-for-Service Program†, notes that the Centers for Medicare and Medicaid Services proposed moving from a pay-for-reporting program to a pay-for-performance program as part of the Deficit Reduction Act of 2005 (14). The start of this pay for performance program, which was best known as the Hospital Value Based Purchasing program would change the future and the practice of medicine in hospitals and other healthcare facilities for many years to come. This program drove the most change in care provided to Medicare patients. According to CMS.gov: On April, 29, 2011, the Centers for Medicare Medicaid Services issued the final rule establishing the Hospital Value Based Purchasing program†¦This program, which was established by the Affordable Care Act, [would] implement pay-for-performance†¦The final rule adopt[ed] performance measures, drawn from the measure set that hospitals have been reporting under the Hospital Inpatient Quality Reporting program. During his presentation at the Agency for Healthcare Research and Quality on September 14, 2009, Michael T. Rapp, MD, JD, FACEP, Director, Quality Measurement, and Health Assessment Group, listed the supporters for the Hospital Value Based Purchasing program. Supporters included the Institute of Medicine, private health plans, and employer coalitions. When the Institute of Medicine released their â€Å"To Err is Human and Crossing the Quality of Chasm Report† they called for â€Å"raising standards and expectations for improvements in safety through the actions of oversight organizations, professional groups, and group purchasers of health care† (6). The support for the Hospital Value Based Purchasing program could be seen as early as November 1999 in the IOM report, â€Å"One way this can happen is by purchasers and consumers requesting and using information to direct their business to the best organizations and providers in a community† (19). For many years, th e need for standardization of care was needed and no other program but the Hospital Value Based Purchasing program could have brought that change. The quality of care given by providers would now be an open book and this would surely drive significant change. The supporters felt the program would bring change but there were also those opposing the Hospital Value Based Purchasing program. Opposition for the program came from hospitals, state hospital associations, and physician associations. Those with oppositions felt the program would pose significant operational challenges due to the number of measures being reported. Smaller hospitals would have the most challenges due to hiring additional work force to perform the chart abstraction required to report on the measures. Some measures would also require changes in processes that often take financial resources. To summarize the 2008 Modern Healthcare article, many healthcare groups felt the Centers for Medicare and Medicaid Services was heading in the right direction by implementing the Value Based Purchasing Program but felt such a program should not be used to reduce Medicare spending (Lubell 1). The healthcare groups felt the program would lose credibility among providers since it was o nly a short-term fix to reduce Medicare spending (Lubell 2). The first year of payment with the Hospital Value Based Purchasing program would be fiscal year 2013. With this program, hospitals would need to show improvement over the baseline during the performance period. The Centers for Medicare and Medicaid Services established that the baseline period would come from measures previously reported to the Hospital Inpatient Quality Reporting Program for discharges from July 1, 2009 – March 31, 2010 and the performance period would be July 1, 2011 – March 31, 2012. The initial measures included twelve of the Hospital Inpatient Quality Reporting Program measures. Since these were the original pay for reporting measures, many hospitals had already been working on improving their performance. The use of previously reported measures also helped many facilities know where they needed to improve. The results of patient satisfaction surveys would also be part of the program. The Centers for Medicare and Medicaid Services required hospital s to survey patients with a survey know as the Hospital Consumer Assessment of Healthcare Providers and Systems survey. The initial measures were all measures that focused on processes. These included providing discharge instructions to patients, controlling a patient’s glucose after having heart surgery and ordering venous thromboembolism prophylaxis to surgical patients. Although patients would have better outcomes, such as less pulmonary embolisms and less infections with these measures, the use of process of care based measures would only show improvement in changes made to processes. The process measures that showed the most improvement over the baseline included Primary Percutaneous Coronary Intervention Received Within 90 minutes of Hospital Arrival and Postoperative Urinary Catheter Removal on Post Operative Day 1 or 2. The Primary Percutaneous Coronary Intervention measure improved by 1.9% from 93.44% to 95.34% showing the percentage of heart attack patients who had the blocked vessel causing the heart attack to be opened up with in 90 minutes of arriving to the hospital. The urinary catheter improved from 92.86% to 95.79% for an overall improvement of 2.93%. Surgical patients often need a urinary catheter after surgery. If left in place for too long patients can develop an infection. This indicator measured the percentage of patients who had their urinary catheter removed with in first or second day after they had surgery. These two measures are some of the few process measures that made a difference in the care and outcome of patients. The Primary Percutaneous Coronary Intervention measure improved the chances of survival for heart attack patients and the urinary catheter measure helped prevent infections. Patients who survived a heart attack as a result of the care they received at a hospital are surely to tell others of their experience. Word of mouth is the most common source of recommendation for a product, restaurant, or even hospital. The New York Times reiterates this in an October 2013 article by stating, â€Å"While private and public payers are making important progress on performance measures and outcomes-based reimbursement, patients still rely largely on the recommendations of loved ones and friends about the quality of care provided by individual doctors, hospitals and other providers†(Blando 2). Although this may be true, the Centers for Medicare and Medicaid Services still created the Hospital Compare website. The website would provide consumers information on how hospitals compared to other hospitals on each of the process of care measures. The website could be compared to the Consumer Reports website in that prior to making a major purchase consumers can research information on the quality of the product they plan on purchasing. This website would enable the consumer to make an informed decisio n regarding their healthcare. It also opened up a world of transparency for hospitals and consumers. Quality data on hospitals had never been shared with their competitors or their patients. Hospitals changed many processes in order to improve their performance of the measures that were displayed on the Hospital Compare website. Can it be determined if there has been improvement in the care provided or is it still to early to tell? In an attempt to answer this question, the Centers for Medicare and Medicaid Services contracted with the Rand Corporation to evaluate the effects of the Hospital Value Based Purchasing program. In 2014, the Rand Corporation released their research report entitled â€Å"Measuring Success in Health Care Value-Based Purchasing Programs†. Their research found only â€Å"49 studies that examined the effect of P4P on process and intermediate outcome measures† (xxi). The RAND article states, â€Å"Any identified effects were relatively small† (xxii). When compared to the initial baseline period, the process of care measures have shown improvement during the performance periods. This journey has been painful for so many facilities. Many of which were not prepared for how quickly the pay for performance program would become reality. Although this program has increased the amount of work for facilities, many have worked diligently to ensure the changes needed to processes to improve patient care were implemented. Improvement in care will only be seen with the implementation of outcomes based measures. As stated above, more heart attack patients have survived. Fewer infections from urinary catheters being taken out in a timely manner will most likely be seen. In the future, the outcome measures should be better predictors of the effects of the pay for performance program. Examples of outcomes based indicators includes measuring readmissions back to hospitals, measuring infections and measuring mortality of patients for the four common conditions mentioned in the previous paragraphs. The Centers for Medicare and Medicaid Services only recently implemented these outcomes measures. As with the process of care measures, until additional years of data are available their effect cannot be determined. At this time with the limited data available, it is s till too early to tell if the Hospital Value Based Purchasing program has made an impact on the care provided to Medicare beneficiaries.

Diabetes Mellitus Essay -- Disease, Disorders

Diabetes mellitus (DM) or simply diabetes, is a chronic health condition in which the body either fails to produce the amount of insulin needed or it responds inadequately to the insulin secreted by the pancreas. The three primary types of diabetes are: Diabetes Type 1 and 2, and during some pregnancies, Gestational diabetes. The clichà © for all three types of diabetes is high glucose blood levels or hyperglycemia. The pathophysiology of all types of diabetes mellitus is related to the hormone insulin, which is secreted by the beta cells of the pancreas. This hormone is responsible for maintaining an optimal glucose level in the blood. It allows the body cells to use glucose as a main energy source. Due to abnormal insulin metabolism, in a diabetic person, the body cells and tissues cannot make use of glucose from the blood, resulting in elevated blood glucose level or hyperglycemia. Over time, elevated blood glucose level in the bloodstream can lead to severe complications, such as disorders of the eyes, cardiovascular diseases, kidney damage and nerve destruction. In Type 1 diabetes, the pancreas is not able to produce sufficient amount of insulin as required for the body. The pathophysiology of type 1 diabetes suggests that it’s an autoimmune disease, in which the body’s own immune system generates secretions of substances that attack the beta cells of the pancreas leading to low or no insulin secretion. This is more common in children and young adults before the age of thirty. Type 1 is also referred as Insulin dependent Diabetes Mellitus or Juvenile Diabetes, exogenous insulin is needed for its treatment. In type 2 diabetes mellitus we find insulin resistance with varying degrees of insulin secretory defects and is more comm... ... advice to wear comfortable shoes, preferable leather, and not to walk barefoot. Maintaining proper weight and exercising regularly is essential. Early and correct detection of the type of diabetes is necessary to prevent severe health complications. Reference List Bernstein, R. (2007). Dr. Bernstein’s diabetes solution, New York, Little, Brown and Company Becker, G. (2011). Type 2 diabetes, New York, Marlowe & Company Khardori, R. (2011). Type 1 Diabetes Mellitus. Retrieved from http://emedicine.medscape.com/article/117739-overview Retrieved from http://www.mayoclinic.com/health/type-1-diabetes/DS00329/DSECTION=ca 1998-2012 Mayo Foundation for Medical Education and Research (MFMER). By Mayo Clinic Staff Silvestri, L. (2010). Comprehensive review for the nclex-pn examination Saunders; 4 edition Linda Anne Silvestri (March 5, 2009)

“Philip Condit and the Boeing 777

The case study „Philip Condit and the Boeing 777: From Design and Development to Production and Salesâ€Å" deals with the launch and development key points of the Boeing 777 model in the 90s. Generally, the aircraft industry is described as a very risky one as failure is the norm due to high product development costs. Furthermore it consists of a rival duopoly of the survival jet makers Boeing and Airbus. The Boeing company’s history of producing jets can be split into two eras. In the 1920s, 1930s and during Worlds War II., it was a military contractor producing bombers and fight aircraft. Later on, in the 1950, Boeing became the world‘ s largest manufacturer of commercial aircraft. Their first jet was the 707 model. Although Boeing was very successful, Airbus remained a serious rival. In 1988, Boeing planned to upgrade the 767 model in order to meet the level of Airbus‘ competition which launched two new models. As Boeing had no 300-seat jetlines, nor plans to develop such a jet, the Executive Vice President Philip Condit proposed to design a 767 double-decker jet. To explore the risks, he tried to find out if the customers were interested in such a launch. But United Airlines rejected the idea of a 767 double-decker, as it had no chance against Airbus‘ new model transports. Instead, Condit was won over to develop a completely new commercial Boeing jet which would be called the 777 project. One of the main characteristics of the Boeing 777 jet was that it was a consumer driven product. In order to decrease the risk of developing the new jet, Boeing approved the project only until it obtained 68 firm orders of the 777 jet by the carrier United Airlines. Only then Boeing commited to the 777 program and the directors approved the close cooperation of the two companies. For the design and development phase Boeing introduced the „Working Togetherâ€Å" with eight more carriers. Furthermore Boeing 777 was a globally manufactured product, for which 12 international companies were contracted. Boeing split the risk of the new product on a family of planes consisting of different planes build around a basic 777 model. By that, the design included a maximum flexibility for future changes of the model according to customer preferences. Besides these facts, the 777 project delivered the first jetliner designed entirely by computers. Instead of old-fashioned two-dimensional methods, the sophisticated computer program „Catiaâ€Å" (computer aided three-dimensional interactive application) had been used. Furthermore, all team members were connected according to Catia, which made them be cross-functional. During the 777 project, Boeing implemented a new company culture, where assembly line workers were empowered and encouraged to offer suggestions and participate in the desicion making. Managers also payed attention to problems faced by their workers, such as safety concerns, childcare, etc. The Leadership and Management style changed from a secretive one to open communication among employees; from an individualistic mentality to teamwork. In the 1990 the new 777 aircraft program had been launched and in 1995 the first jet had been delivered, while in 2001 the 777s were flying in the service of major U.S. and international airlines. Although Boeing produced the most successful commercial jetliner, it was a risky project and its process contained unresolved problems. Problem statement The main concern of Boeing was its insufficiency to reach the competitive level of its only rival, Airbus. While Boeing had no plans to even develop a 300-seat jetline, Airbus had launched in 1988 two new successful models. Condit’s proposition of a modernization of the already existing 767 model by upgrading it to a double-decker jet, had been refused by United Airlines. United’s contra argument was that a Boeing 767 double-decker was no match to Airbus’s new model transports. Boeing’s challenge was to create a completely new commercial jet model which should not only be the preferred airplane in the aircraft industry, but at the same time be launched at a competitive price. The most costly and risky part of the development of an aircraft was the production of the jet engine. Its production could cost as much as producing the airplane itself. By deciding to develop a completely new 777 model instead of updating the older 767 model, a new engine had to be developed. Although Boeing had been strong in the 90s, the project still was risky. A failure of the costful new jetliner might have led to a decline of the Boeing company. The question was how to develop technological and managerial innovations to cut costs. Those innovations in aircraft design, manufacturing and assembly were supposed to update Boeing’s engineering production system and manufacturing strategies. The case focuses on efforts done to survive in the aircraft market by modernization, success and cost effectiveness. All efforts finally run to the question, if Boeing will achieve a better competitive position to Airbus. Data analysis The main problem of the company arouse because its latest, eight-year-old, wide-body twin jet 767 Boeing model, even if upgraded and turned into a double-decker, still couldn’t be a match to Airbus’s new 300-seat wide-body models (the two engine A330 and the four engine A340). If Boeing wanted to have future on the market, it quickly had to resolve this issue by planning a way of enhancing its competitive position relative to Airbus. Boeing was also being urged by the United Airlines and also by other airline carriers to develop a brand new commercial jet, which was even expected to be the most advanced airplane of its generation. The decision to be made in terms of this issue lies in the responsibility of Frank Shrontz, Boeing’s CEO, in 1988. The stakeholders to be further affected by it were the future customers of the 777 Boeing model – airline carriers from all around the world, like United Airlines. Also relevant to the outcome of Shrontz’s decision were the manager Philip Condit, put in charge for the 777 project, as well as all the others 10 000 employees and lower level managers, that were recruited to work on it. The situation was going to affect as well Boeing’s suppliers for structural components, systems and equipment, which were twelve international companies located in ten countries. As first constrain for resolving the issue we can note that Boeing’s production system and manufacturing strategies were outmoded and needed to be updated. In order to create an aircraft, which could compete with Airbus’s latest ones, Boeing first needed to revitalize their mass production manufacturing system. Airbus also was ahead of Boeing because of their use of the most advanced technologies, and therefore Boeing had to introduce leading edge technologies into its jetliners. If we look at Exhibit II in the business case, we will see the market share of shipments of commercial aircraft of Boeing, McDonnell Douglas (MD) (until 1997, before the merger with Boeing) and Airbus, for the period 1992 – 2000. The percentage numbers on the table show the competitive relationship between Boeing and Airbus, especially when they remain the only players in the industry in 1997. Airbus is steadily raising the percentage of its market share of shipment throughout the years, for Boeing’s misfortune respectively. From here we can extend more our understanding of the threat that Boeing had in the face of Airbus and also of the need for the CEO of Boeing to come up with a solution for how to strengthen its competitive position.

Security Standards And Security Safety Standards - 812 Words

Government Security Standards The government and organizations are to comply with security laws and regulations in order to fully operate and maintain protection of information systems. Some of these security laws and regulations may vary for every industry and with some organizations; however, implementing security standards with a broad in scope provides reliable reasonable security. In many cases reasonable security implemented throughout the information system can include a high-level of protection in the operation of government and organization systems. There are best practices and risk management frameworks tools to consider when providing a higher level of security in the performance and protection of information systems. It’s key to maintain effective security policies that are fulfilled by security standards and tools to help manage the protection of the information systems. Security standards are required to carry out the details of an effective security policy. One common standard in security standards is to ensure ethics are maintained in a lawful way. The difference between government and commercial security standards is government security standards focus on compliance with security policies that deal with national security; whereas, health organizations maintain security standards that focus on compliance with security policy that ensure the privacy of health records. The security policy provides the rules of protection for the information system andShow MoreRelatedBitcoin Is Becoming Too Stronger955 Words   |  4 Pagesto cybersecurity risk and threat. Breaking news from cyber security world Hardly had the Bitfinex community recovered from $70 million theft, when it again suffered a heavy cyber attack in February 2017. One of the largest cryptocurrency exchanges became a prey to massive DDoS attack. It paralyzed the operation of a trading platform for hours. Another piece of news that knocked bitcoin holders down came earlier this year. 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