ipl-logo

Reimbursement Essay-Pay-For-Performance In Nursing Homes

862 Words4 Pages

Pay-for-Performance in Nursing Homes
Pay for performance is a type of provider reimbursement system where the healthcare network of providers is incentivized for maintaining quality measures and standards in the treatment of their patients. Most of the times these incentives are monetary in nature. This type of payment strategy is relatively new in healthcare. This holds true even more in the case of nursing homes as compared to hospitals and health provider offices. One reason out of many, I believe is that the nursing homes are mostly state funded and have less leverage of experimentation in their operations. P4P is still in the evolving and experimental stage as claimed by the CMS (Centers for Medicare & Medicaid Services). Rigorous evaluations of the impact of pay¬-for-performance are almost nonexistent in the nursing home setting, yet they are critical for understanding the implications of this policy. It is very difficult to …show more content…

This adversely affects the results of the measures. The philosophy behind P4P is that the pay is proportional to merit and in merit is measured in quantified terms. But when it comes to healthcare it is a complex phenomenon. It is difficult to talk about the performance in numerical terms. If we assign points to every activity of a healthcare personnel like a nurse or a doctor, then we might face a situation in which the doctor or nurse making their priority as earning the points rather than what is most important for the patient. This might include cost reduction activity which is bad for the poorer nursing homes.
It is reassuring to see that the NHVBP (Nursing Home Value-Based Purchasing Demonstration) will use an experimental design having randomized assignment of nursing homes participating into treatment and control groups and has already implemented an independent

Show More
Related
1323 Words | 6 Pages

Developing a reputable compensation plan for a medical facility can bring a lot benefits when properly developed. Although the Mapleton Family Medicine has presented nearly an excellent incentive system plan, there are still things that should be considered. 1. Patience: Benefits such as added compensations can actually be extremely complex, requiring a certain degree of legal precautions; therefore, shouldn’t be rushed. The plan should develop over time, allowing appropriate factors to be researched and determined.

Read More
362 Words | 2 Pages

In addition, it wanted to improve the quality of health insurance and healthcare by doing things such as rewarding hospitals

Read More
595 Words | 3 Pages

The first model provides retrospective reimbursement based on inpatient prospective payment system. The second model provides retrospective reimbursement passed on care episodes of extended set times (1, 2, or 3 months) post discharge from hospital; the third model provides payments associated with post acute care episodes following discharge from hospital; and the fourth model offers prospective payments which include all services provided during hospitalization and includes all 30-day readmissions. These Bundled Payment Plans enable providers to focus on providing more effective care that focuses on patient outcomes and research, with the awareness that a standard required care be provided within a set allotment, rather than reimbursement based on quantity of services provided, or certain billing code, as currently

Read More
747 Words | 3 Pages

Reimbursement Methods What are the definitions of and the similarities and differences of the following reimbursement methods; capitation, discount, per diem, case rate, DRG’s/MS-DRG’s? Starting with capitation. Capitation is prepayment for services, per member per month. A physician or facility is paid the same amount of money every month for each member or patient regardless if that patient is actually seen or receives services and regardless of how extensive of services that member/patient have received. The capitation amount is calculated and set at the fixed amount usually for one year.

Read More
475 Words | 2 Pages

Healthcare reimbursement plans are an employer-funded, tax advantaged health benefit plan that allows companies to reimburse employees for their medical expenses. This plan is not health insurance, but it is a way to provide an allowance to employees that they can use on their medical expenses. Nurse practitioners must be fiscally responsible to obtain reimbursement for provided services. In order to accomplish this goal knowledge of the reimbursement process is required.

Read More
626 Words | 3 Pages

In terms of insurance, it would still be presentable towards the private-public service however an additional fee will be required to ensure a better quality of services. By initiating this idea, hospitals will start to become more efficient since they are providing more options to receive treatment and the decision will ultimately be based upon the view of the

Read More
327 Words | 2 Pages

In the past, nursing homes have notoriously been known for not delivering the best quality care. There have been cases of patients being burned by heating pads, strapped to their beds with restraints, or given medication to quiet them down, with more extreme cases including patients so sedated, that they almost seemed lifeless. In 1987, the Nursing Home Reform Law was passed to change the quality of care being given to nursing home residents such as monitored clinical care, unexpected inspections, and having a registered nurse on duty 24 hours a day. While its creation had many positive effects, there was still an issue with the quality of care being given as stakeholders and investors in nursing home chains have begun to cut expenses by limiting

Read More
673 Words | 3 Pages

b) Medicare electronic Health Record Incentive programs for eligible professionals: Mainly, it is a system where the incentive programs are to vitalize the health professionals and hospitals to adopt and upgrade to the use of electronic health record technology. c) Value-based payment modifier: Moreover, it is a system which provides a payment for the group of physicians under the Physician Fee Schedule of Medicare where the quality of care is considered rather than the cost of care during the performance period for the physician. and with these processes are imported into the Merit-based Incentive Payment System. Correspondingly, physicians and other health professionals will be determined in Merit based Incentive Program system under four performance categories i) Quality

Read More
523 Words | 3 Pages

It's how Medicare and some private insurance companies pay hospitals for the care of patients (Cherry, Jacob, 2014 p. 109). The payment is fixed and predetermined per diagnosis. If the hospital spends less than that set price to treat that patient then they make money, if they spend more they lose money. Prompting hospitals to reduce services as much as possible so they can make a profit. Cherry, B., Jacob, S.R. (2014).

Read More
474 Words | 2 Pages

Medicare reimbursement services can also provide incentives for healthcare providers to focus on preventative care and chronic disease management. For example, Medicare offers financial incentives for providers who participate in programs that focus on reducing hospital readmissions and improving care coordination for patients with chronic

Read More
869 Words | 4 Pages

Depending on which approach is being used the cost for bed/day, medical treatment and nursing care can be higher and lower. With this new

Read More
483 Words | 2 Pages

Long-term care insurance pays for nursing home expenses as well as home health care. The insurance is meant to cover the cost costs associated with long-term care for those who have had strokes, chronic diseases, or Alzheimer’s diseases, as well as those who can simply no longer manage to live on their own. Moreover, it is another form of disability insurance, and its downside is that it is expensive according to Keown (2007). However, there are plenty of cost-benefits to purchasing long-term care as it is meant to protect you against the financial consequences of the high cost of increasing life expectancies and the resultant rise in the chance that you may eventually need some level of care. In other words, long-term health care insurance is meant to protect you against the financial consequences of such cost.

Read More
594 Words | 3 Pages

Although the ACA sought to provide affordable health care and reduce the cost of quality care, the legislation prevents the federal government from using the cost of care, as well is information about the cost-effectiveness of care, in Medicare coverage decisions. Currently, only comparative effectiveness analysis is permitted. When determining which care should be provided, decision-makers may compare which treatment options would be most effective and cause least harm, but cost may not be a consideration. Each of the policy experts at the TMC policy forum meeting vehemently agreed that cost discussions must be part of the equation.

Read More
792 Words | 4 Pages

The Centers for Medicare and Medicaid Services is according to Briesacher et al (2009), is thought to be the principal consumer of nursing home services. Pay for Performance in Nursing Homes Briesacher et al (2009), identified in their article that enough information was not available on the use and impact of pay for performance in nursing homes. It was to this extent that in the summer of 2009 there was an implementation of a pay for performance I nursing homes in a few States. The information which was readily available indicated inconsistencies in outcomes and quantity of care. The incentives awarded had no clear demarcation for reason associated with awards.

Read More
432 Words | 2 Pages

The purpose of annual PA is to ensure the staff ability the change with the changes in healthcare. It is a tool used by management to ensure the staff know and understand the nature of their job with the changes in healthcare. Today people have option in healthcare, and with Obamacare even more people are weighing their options on where to go to receive quality care. Nursing is no longer about caring for the sick, it’s about delivering quality patient centered customer service. PA includes an “identification of professional development needs, helping nurses to determine that which they could do to improve their practice, advance their skill and derive continuing satisfaction form their work” (Price, 2013, p.50).

Read More

More about Reimbursement Essay-Pay-For-Performance In Nursing Homes

Related Topics

Open Document