1. Incentive Programs in Healthcare discussion
Incentive Programs in Healthcare discussionIncentive Programs in Healthcare
discussionORDER HERE FOR ORIGINAL, PLAGIARISM-FREE PAPERSColossians 3:23 says,
“Whatever you do, work heartily, as for the Lord and not for men.” As a part of quality
assurance, the government has instilled various programs as incentives for various health
care facilities and health care professionals. Like the Meaningful Use program, other
programs that are offered by the government “look to incentivize healthcare providers
through demonstrating the delivery of quality healthcare and a commitment to quality
patient outcomes” (Harrington, 2016, p. 269). Holmstrom (2017) reported that an incentive
program or system that is properly designed will consider the full collection of services that
a healthcare provider or facility “can engage in, the array of instruments, many nonfinancial,
that are available to influence individuals and consider the factors that motivate them in
different settings” (p. 1735). Two of the incentive programs that we will look at further are
the Pay-for-Performance (P4P) program and the Value-Based Purchasing (VBP) program.
Both programs are based on quality care, but P4P deals with healthcare providers while
VBP deals with acute care hospitals. Incentive Programs in Healthcare discussionUp until
the 1990s, healthcare providers were reimbursed based on a fee-for-service system.
Entering into the 1990s, healthcare payers shifted to a managed-care approach that
included primary care physicians and case managers. With the continued escalating
healthcare costs with little to no improvement in the quality of healthcare services, the P4P
payer system was introduced in the early 2000s. When healthcare providers meet or exceed
agreed-upon quality measures or performance goals, they will be provided with a bonus
from the P4P program (Harrington, 2016). Healthcare providers can also be penalized for
not providing quality care, not reducing healthcare costs, and even performance that is not
improving. This places pressures on the healthcare providers to ensure that any healthcare
services provided to patients are “safe, effective, patient-centered, timely and efficient in its
delivery, and equitable for the patient” (Harrington, 2016, p. 271). Quality measures that
are imposed on healthcare providers are categorized as process measures, outcome
measures, patient experience, and structure measures. P4P payments to service providers
are then calculated based on services rendered, the quality of services, and efficiency
measures. Harrington (2016) stated that the overarching goal for the P4P program is to
accurately align both the incentive program itself and the payment to providers’ processes
and goal in order to eventually “produce better outcomes for the patient that will ultimately
result in lower costs for the payer, provider, and patient” (p. 273). In comparison, the VBP
2. program bases its program on a majority of the same provisions, but the program operates
and requires different measures to differentiate warrant of payment. Incentive Programs in
Healthcare discussionThe VBP program is an initiative by the Centers for Medicare and
Medicaid Services (CMS) “that rewards acute-care hospitals with incentive payments based
on the quality of care that they provide to the beneficiary/patient that is on Medicare while
in” the health facilities care (Harrington, 2016, p. 274). The VBP program essentially
rewards healthcare providers for delivering both quality and efficient clinical care. The VBP
program can be complex but basically, any incentive payment is based on how well
inpatient healthcare services perform based on each measure or on how much
improvement, or lack thereof, has been made in that specific area since the previous
measurement or baseline period. Just as in P4P, there are a handful of quality domains that
hospitals are measures on, these include—the clinical process of care, patient experience of
care, outcome, and efficiency. Any healthcare facility that participates in the VBP program is
not only under a microscope, so to say, but also their performance is completely transparent
to the public. Information gathered on a hospital’s performance in the VBP program is
posted periodically for public review. This information includes “the hospital’s performance
on each measure that applies, the hospital’s performance on each condition or procedure,
and the hospital’s total performance” (Harrington, 2016, p. 278). Chee, Ryan, Wasfy, and
Borden (2016) reported that VBP programs “will play a significant role in healthcare
delivery for years to come, and they will serve as an opportunity for providers to build the
infrastructure needed for value-oriented care” (p. 2197). Both the VBP program and the
P4P program have initiated measures for improving the quality of healthcare services and
healthcare professionals’ performance, while aiming at reducing healthcare costs. The
overall impact of both the P4P program and the VBP program on any healthcare
organization that is participating is that the overall financial health of the healthcare
organization is directly affected by any unfavorable outcomes. Incentive Programs in
Healthcare discussionReferencesAmerican Bible Society. (2000). The holy bible, containing
the old and new testaments.Chee, T. T., Ryan, A. M., Wasfy, J. H., & Borden, W. B. (2016).
Current state of value-based purchasingprograms. Circulation, 133(22), 2197-2205.
doi:10.1161/CIRCULATIONAHA.115.010268Harrington, M. K. (2016). Health care
finance and the mechanics of insurance andreimbursement. Burlington, MA: Jones &
Bartlett, 2016. ISBN: 9781284026122.Holmstrom, B. (2017). Pay for performance and
beyond. American Economic Review, 107(7), 1753-
1777.doi:10.1257/aer.107.7.1753……………………………………………………………………………………
………………………………………………………………………………….classmate #2-The U.S. health care
delivery system does not provide consistent, high quality medical care to all people
(Institute of Medicine, 2001). Americans should be able to count on the quality of care they
pay for, as to meet their needs and are based on the best scientific knowledge (Institute of
Medicine, 2001). To initiate process of change in the area of quality, there is a need for
changes in the areas of applying evidence to health care delivery; using information
technology; preparing workforce; and aligning payment policies with quality improvement
(Institute of Medicine, 2001).It has been widely adopted by health care providers, and it
seems it would improve the quality of care, however, research finds very mixed evidence of
3. that result, as there is no evidence between P4P and actual improvement of quality, nor the
evidence exists that hospitals, which improved in some areas, were able to sustain the
improvements (Warner et al., 2011). Studies from U.S. fail to find any improvements made
in care process, however, the P4P did decrease readmission rates for Medicare beneficiaries
(Mendelson et al., 2017).The Hospital Value Based Purchasing (VBP) Program is a CMS
initiative that rewards acute care hospitals with incentive payments based on the quality of
care that they provide to Medicare beneficiary under their care (Harrington, 2016). The VBP
was established under the ACA in 2010 and begun applying its payments for the fiscal year
2013 and had an impact on 2,985 hospitals across country (Harrington, 2016). There are
about 3,000 hospitals across country that are eligible for VBP (Harrington, 2016), which are
penalized or rewarded based on how well they perform on certain quality measures. VBP
refers to a set of performance-based payment strategies that link financial incentives to
health care providers’ performance on a set of defined measures to achieve better value
(Damberg et al., 2014). VBP program excludes some hospitals that do not have a minimum
number of cases from participation, like psychiatric institutions, oncology centers, or
pediatric facilities; and hospitals that do not participate in the Hospital Inpatient Quality
Reporting Program (Whitman, 2016). This year, CMS announced several changes to VBP,
introducing four domains on hospital scores, with patient and caregiver centered
experience and care coordination; safety; efficiency and cost reduction, removed two
measures from clinical care and added a care transition dimension (Whitman, 2016).Past
decade has been a one big experiment with pay-for- performance payment systems,
primarily with P4P. However, we still know very little about how to design and implement
VBP programs to achieve stated goals and what constitutes as a successful program
(Damberg et al., 2014). As of today, hospitals are assessed based on comparison to its peers
and its own performance over time. According to research, about 1,600 hospitals will see
bonuses from Medicare in 2017 under VBP (Whitman, 2016). The lowest performing
hospitals will see a reduction in DRG payments of 1.83%, and the highest performing
hospitals will see an increase of more than 4% (Whitman, 2016). Compering numbers of
hospitals from 2016 to 2017, numbers of hospitals that payments were deducted grew from
1,236 to 1,343, accordingly (Whitman, 2016). According to researchers and critiques of
VBP, this design has a flow, as it set up as a tournament style, in which hospitals are stacked
up against each other, and really do not know how they perform until very end (Whitman,
2016). With this year’s changes in major domains on which hospitals are scored, we will
gain new perspective on how progress on quality can be accelerated when pay-for-
performance programs reward both achievement and improvement (Whitman, 2016).Since
we are discussing pay for performance programs, I thought it was fitting to talk about
earthly rewards. In the bible there is a scripture that says, “whatever you do, work heartily,
as for the Lord and not for men, knowing that from the Lord you will receive the inheritance
as your reward. You are serving the Lord Christ” (Colossians 3:23-24, NIV). Everything that
we do as healthcare administrators we should look at it as a service to the Lord. We should
do it gladly and to the upmost of our ability. We are his servants as we do his will on earth
the reward is the individual that we bring to Christ just based on our day to day operations.
The pay for performance program is set up the same way as the bonus or reward is based
4. on exceeding the quality standard that is set.ReferenceDamberg, C., Sorbero, M., Lovejoy, S.,
Martsolf, G., & Mandel, D. (2014). Measuringsuccess in health care value-based purchasing
programs: Findings from an environmental scan, literature review, and expert panel
discussion. RAND Health Quarterly. Vol. 4, No. 3. Retrieved
from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC51613…Harrington, M. (2016).
Health care finance and the mechanics of insurance and reimbursement.J&B
Learning.Institute of Medicine. (2001). Crossing the quality chasm: A new health system for
the 21stcentury. National Academies Archives. Retrieved
from: http://www.nationalacademies.org/hmd/~/media/Files…Mendelson, A., Kondo, K.,
Damberg, C., Low, A., & Kansagara, D. (2017). The effect of P4Pon health, health care use,
and process of care: A systematic review. Annals of Internal Medicine. Retrieved
from: http://annals.org/aim/fullarticle/2596395/effects-…Warner, R., Kolstad, J., Stuart, E.,
& Polsky, D. (2011). The effect of P4P in hospitals: Lessonsfor quality improvement. Health
Affairs. Vol. 30, No. 4. Retrieved
from: https://www.healthaffairs.org/doi/full/10.1377/hlt…Whitman, E. (2016). Fewer
hospitals earn Medicare bonuses under value-based purchasing.Modern Healthcare.
Retrieved from: http://www.modernhealthcare.com/article/20161101/N…
