NUR 621 Do you think it is important for health care organizations to be paid for quality of performance?

According to Sura and Shaw, quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes. This is based on evidence based professional knowledge and is necessary for achieving universal health coverage. Sura and Shaw further explain that Payers assess quality based on patient outcomes as well as a provider’s ability to contain costs. Providers earn more healthcare reimbursement when they are able to provide high-quality, low-cost care as compared with that of their peers The pay-for-performance (P4P) initiatives have been suggested as a way to improve the quality of patient care and provide incentives to improve performance from providers.

In 2003, The Centers for Medicare & Medicaid Services endorsed this P4P initiative to strengthen quality measures, improve patient outcomes and maintain physician accountability. It offered incentives to hospitals, provider groups, and physicians based on adherence to specific metrics. What the data showed was that quality composite scores promoted by CMS with the P4P programs needed improvement. They focused on initiatives to target high and low performers and ways to influence care. The goals of the project were straightforward and that was to reward or financially incentivize healthcare stakeholders to provide high quality care.

I think rewarding rates of improvement is important as it can potentially drive healthcare systems to produce higher results. It encourages organizations to invest in quality improvement. By creating financial incentives for providers to participate in P4P, it allows providers to focus on patients’ specific needs. According to Penner, there were also fewer hospital readmissions within two years following the implementation of a readmission reduction program, particularly among Medicare patients (Penner, 2016). I think that our healthcare industry is ever evolving but changes are continuously strengthening our system.

Penner, S. (2016). Economics and financial management for nurses and nurse leaders (3rd ed.). Springer Publishing Company

Sura, A., & Shah, N. R. (2010). Pay-for-Performance Initiatives: Modest Benefits for Improving Healthcare Quality. American health & drug benefits, 3(2), 135–142.

It is important for healthcare organizations to focus in improving and providing quality of care to their patients. Quality of performance would involve improving healthcare delivery to patients in their community. Healthcare organizations would need to focus on identifying where their facility is lacking. Performance improvement helps healthcare organizations identify what type of quality of care is being provided to patients and allows the healthcare organization make improvements based on the feedback that is being provided. Healthcare organizations should be paid based on their performance providing quality of care. I think it is important and necessary to evaluate what type of care healthcare is being provided to patients. Providing top notch quality of care to the community would also bring other benefits to healthcare organizations by stressing quality of care over quantity of care. This incentive of getting paid for quality of care would allow healthcare organizations to focus more on their practices, processes, and policies to provide and promote positive health outcomes. Patients deserve to receive excellent patient care while keeping the cost of care down. That is why it is so important for nursing professionals track patient satisfaction and reducing cost by measuring patient outcomes. Measuring performance outcomes will allow the organization to achieve and improve patient quality of care.

References

Agency of Healthcare Research and Quality. (2020). Quality Improvement in Primary Care. https://www.ahrq.gov/research/findings/factsheets/quality/qipc/index.html

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS According to Sura and Shaw, quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes. :

The current drive is to provide consumers with education in order to make informed choices. You see this with the Medicare Compare websites, the emphasis on transparency, and the mandated quality reporting measures.

According to the American Medical Informatics Association (n.d.), health consumer informatics is a field that focuses on informatics from multiple perspectives or patient views. The emphasis is on consumer education and health literacy through information structures and processes to manage their own health.

We are seeing this emphasis in our own organizations. Web sites have become much easier to navigate. We are seeing increased access to patient education materials on our site that are easy to understand. Patient preferences for education are being assessed upon admission to organizations.

“The shift in this view of informatics analyzes consumers’ needs for information; studies and implements methods for making information accessible to consumers; and models and integrates consumers’ preferences into health information systems” (American Medical Informatics Association, n.d., para 1).

Class – how do you see your patients and consumers using quality to make decisions?

American Medical Informatics Association. (n.d.). Consumer health informatics. https://www.amia.org/applications-informatics/consumer-health-informatics

In the current state of hospitals and physicians increased transparency with their quality metrics this gives the patient the ability for patients to shop around. Patients want and desire higher quality of care and will look for the hospital or physician with higher quality scores. Higher quality of care equated to decreased adverse events, patients do not want to have adverse events in their medical care and will seek a physician to offer the highest quality of care. Value based purchasing or customer focused service attributes to the product the consumer is looking for and if a patient has the ability to equally choose a costly treatment, they will prefer to get eth best value for their money at the higher quality, marked focused focusing situation give the customer the ability to shop around for the best price as well as the best quality (Penner, 2016). We have created a quest for quality in our culture and patient a desire to be free from adverse events and have great quality of care (Rundio & Al, 2021)

Penner, S. J. (2016). Economics and financial management for nurses and nurse leaders, third edition (3rd ed.) [e-book]. Springer Publishing LLC.

Rundio, & Al. (2021). The nurse manager’s guide to budgeting and finance, 3rd edition (3rd ed.) [original]. SIGMA Theta Tau International.

Most industry stakeholders believe that payers and providers need to be on the same page when it comes to agreeing on a common set of measures, but to date, this has been tough to achieve. One reason is that a lack of shared financial risk between payers and providers could lead to more misalignment. For instance, if the company paying the fees is assuming all the financial risk in each value-based contract, its goals will be different than the provider that is in that agreement (LEVENTHAL, 2018). I do believe that it is important for health care organizations to be paid for quality of performance especially if the performance outcome is meeting the set benchmarks for satisfactory patient outcomes. As well as incentives when the outcomes score above the expected average for good patient outcomes.

A study showed contemporary evidence from a population-based primary care system in Hawaii demonstrated that capitated payments were associated with improvements in a Healthcare Effectiveness Data and Information Set (HEDIS) composite quality measure score, as well as a reduction in number of visits. Taken together, evidence from a variety of settings and disease entities does not point to an overall conclusion about the impact of capitated payments on chronic disease quality of care (Tummalapalli et al., 2022). Several factors may explain these mixed findings. First, the capitation payment amount should also be considered, which may differ across Medicare, Medicaid, and commercial managed care settings. Second, practices are subject to different quality metrics and pay-for-performance initiatives depending on the payor arrangement, which incentivize quality of care improvements. Thus, the impact of not only capitation vs. FFS reimbursement type, but also quality metrics and other regulatory requirements, impact quality of care delivery and must be considered in evaluating new capitation models (Tummalapalli et al., 2022).

Increasingly, funders want to see planning and development strategies for maintaining programs beyond the proposal’s funding period. Frequently, the funder’s mission is to only provide seed money to help grant applicants start up the proposed program. Many funders expect applicants to develop plans and strategies for ongoing program operation and sustainability once the grant funding has expired. The section on program sustainability should describe ongoing program operation plans and strategies. For example, the applicant may describe efforts to develop ongoing community partnerships for future resources, or fund-raising strategies. There may be plans to introduce fees for services, or to obtain approval for reimbursement by payers such as Medicaid or insurers. If the proposed program is based within a larger agency such as a nonprofit organization or a health department, plans for increasing agency support beyond the proposed funding period may be discussed (Penner, 2016).

References

LEVENTHAL, R. (2018). In the New Healthcare, Payers and Providers Look to Redefine Quality. Healthcare Informatics, 9–11.

Penner, S. J., RN, , MN, , MPA, , DrPH, , & CNL, . (2016). Economics and financial management for nurses and nurse leaders (3rd ed.). Springer Publishing Company.

Tummalapalli, S. L., Estrella, M. M., Jannat-Khah, D. P., Keyhani, S., & Ibrahim, S. (2022). Capitated versus fee-for-service reimbursement and quality of care for chronic disease: a US cross-sectional analysis. BMC Health Services Research, 22(1), 1–12. https://doi-org.lopes.idm.oclc.org/10.1186/s12913-021-07313-3

I enjoyed reading your post. The quality driven payment systems are dependent on metrics. I think we can all agree that standardizing evidence-based care is the best way to make sure quality is assured across the board. But, one thing I have found in studies associating finances and quality is that it takes quite a bit of finances and resources to build a quality improvement program to begin with (Akinleye et al., 2019; Barnes et al., 2017). It requires a good electronic health record that makes it easy to collect data. Otherwise, it would be a lot of manual data collection, which is expensive in man hours. It also requires staff that are educated in what metrics to collect. A quality director or manager would also be very important inmanaging a processing the data. The staff would need to time to analyze the metrics and develop process improvement projects. Quality care may be more profitable, but it may have a lot of hidden costs that are not accounted for (Akinleye et al., 2019; Barnes et al., 2017). This may lead to poor hospitals getting poorer and rich hospitals getting richer. Medicare and Medicade payments may be less than private payors so a hospital with a higher proportion of Medicare and Medicaid patients may have less money to put into a quality resources. Also, there is also the aspect of socioeconomic factors that are not taken into account. A hospital may need even more strategies and resources if the population has a lot of socioeconomic factors to overcome. Patients may have low income, poor diets, lack of transportation, language barriers, etc. I do think we need to incentivize quality, but maybe the government needs to help these small hospitals with poor finances, to get a quality improvement program going before incuring penalties. We need healthcare facilities to have more incentive to take on Medicare and Medicaid patients.

Resources:

Akinleye, D. D., McNutt, L., Lazariu, V. & McLaughlin, C.C. (2019). Correlation between hospital finances and quality and safety of patient care. PLOS ONE Journal. https://doi.org/10.1371/journal.pone.0219124

Barnes, M., Oner, N., Ray, M. N. & Zengul, F. D. (2017). Exploring the association between quality and financial performance in U.S. hospitals: a systematic review. Journal of Healthcare Finance. file:///C:/Users/Mindy/Downloads/144-290-1-SM.pdf

I think the idea of moving towards paying for quality of care versus quantity of care is the correct idea but has been poorly executed. The movement towards pay for performance (P4P) was important in the fact that it has the opportunity to improve the quality of care while controlling cost since the United States has the most expensive healthcare in the world but not the best outcomes (Joszt, 2016). The idea of providing more money for better patient outcomes and penalties for poor paitent outcomes would make one think that it could easily improve care outcomes pretty quickly. Unfortunately, having a set standard across the board could be a detrimental viscious cycle. Many times providers may practice in rural areas or areas that struggle with access to care. Providers caring for this population of patients shouldn’t be compared to world renowned facilities that have indespensible resources at their finger tips. This has the potential to increase the already very prevalent healthcare disparities amongst minorities and our vulnerable patient populations. This could cause providers to be penalized more simply because of the population served and not truly taking into account the patients being served, their baseline health, and decreased availability of resources (Joszt, 2016). Penalizing providers and decreasing payments more can prevent the money needed to make changes to better the care and accessibility in this setting. While you want to reward for better patient outcomes and not just the number of patients, one needs to keep in mind that there needs to be appropriate implementation and standards for every healthcare setting and provider with the availability of resources for providers and patients.

Joszt, L. (2016, February 26). 5 things about pay-for-performance. AJMC. Retrieved January 18, 2022, from https://www.ajmc.com/view/5-things-about-pay-for-performance

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Maekenzy, I do agree that we are moving towards paying for quality of care versus quantity of care and it may be the correct idea and I also agree that it has been poorly executed. Most industry stakeholders believe that payers and providers need to be on the same page when it comes to agreeing on a common set of measures, but to date, this has been tough to achieve. One reason is that a lack of shared financial risk between payers and providers could lead to more misalignment. For instance, if the company paying the fees is assuming all the financial risk in each value-based contract, its goals will be different than the provider that is in that agreement (LEVENTHAL, 2018). I do believe that it is important for health care organizations to be paid for quality of performance especially if the performance outcome is meeting the set benchmarks for satisfactory patient outcomes. As well as incentives when the outcomes score above the expected average for good patient outcomes.

References

LEVENTHAL, R. (2018). In the New Healthcare, Payers and Providers Look to Redefine Quality. Healthcare Informatics, 9–11.

NUR 621 Do you think it is important for health care organizations to be paid for quality of performance?