Reference no: EM133255683
Assignment:
Value based purchasing is a payment model that offers financial incentives to healthcare providers and organizations when they meet certain performance measures. This model also penalizes healthcare providers for poor outcomes, medical errors, or increased costs. Managed Care Organizations (MCOs), Accountable Care Organizations (ACOs), and Bundled Payment Care Improvement (BPCI Advanced) are prospective value-based purchasing programs aimed at improving healthcare quality and reducing costs. Hospitals and physicians participate in these programs with the goal of getting the right care to the right patient at the right time.
Consider what happens with these systems as they relate to nursing home care. Nursing home administrators are facing a reduction in the demand for skilled nursing rehabilitation (SNF) beds, while physicians in an ACO or a gain-sharer in a BPCI program are looking at discharging patients with home care or outpatient resources to reduce cost. All these programs are affected by re-admission penalties.
Most businesses are constantly looking to reduce cost. In healthcare, often the necessity to reduce cost means a reduction in utilization. Consider how this compares to a retail market where reduced demand reduces cost by consumer choice. How much influence does the consumer have on the change in healthcare economics? Is it the payer (Medicare), the provider (the physician), or the patient?
Consider the following scenarios:
Scenario: You are the manager of a large orthopedic practice that participates in the BPCI program. Your practice does 400 total knee patients each year. Medicare has set pricing for a Total Knee Replacement patient at $28,415 per patient for a 90-day episode of care. Current practice is that all patients automatically go to a skilled nursing facility (SNF) for 20 days. Based on current research the goal is for 60% of your patients to go home with home care and those going to a SNF to stay for 10 days so the BPCI program will be profitable.
To Prepare:
- The scenarios focus on.
- Reflect on the scenario and consider redesign measures you might recommend. For example, consider length of stay, reducing readmissions, attracting new business, care redesign, patient satisfaction, and physician engagement.
Post a comprehensive response to the following:
- Describe at least three care redesign strategies you might recommend to the scenario.
- Justify why you selected these three care redesign strategies and explain how you would implement the redesign strategies you recommended.
- Be specific and provide examples.
- Be sure to support your Discussion with a reference to course materials or a reference within the last three years.