Medicare Value Based Purchasing Program 13-03-12 Medicare Value Based Purchasing Program Introduction: The term “Value Based Purchasing Program” refers to a set of programs designated at providing varying Medicare payment levels on the basis of the quality and efficiency of the Medicare providers…
The implementation of separate value based purchasing programs for each of the different Medicare providers requires more than just trumpeting the program. The program has different payment levels and efficiency measuring strategies for hospitals, physicians and other practitioners, home health agencies, ESRD providers and facilities, and skilled nursing facilities. (Reichard 2009). The Policy: The Medicare Value based purchasing programs have been formulated in an effort to facilitate the transformation of the Medicare system from a passive payer of claims to an active purchaser of care. The operational infrastructure of RHQDAPU as established by the CMS has been used as a base for the development of Medicare Value based purchasing programs which includes the following provisions: i. As specified by the President’s FY2006 and FY2007 budgets, the value based purchasing programs are budget neutral and are formulated in accordance with the policy recommendations of Institute of Medicine (IOM) and Medicare Payment Advisory Commission (MedPAC). ii. The existing Medicare performance measurements and reporting infrastructure together with RHQDAPU components have been used as a foundation for the structure of Value Based Purchasing Programs. iii. ...
In accordance with the provisions of Patient Protection and Affordable Car Act of 2010, the data collected in the initial year would be utilized in informing the concerned medical individuals about their incentive payments. v. The implementation and coordination of VBP program would be undertaken by CMS, which will also monitor the effectiveness of the program through consensus processes such as Hospital Quality Alliance (HQA), National Quality Forum (NQF), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). vi. The reporting requirements specified in Division B, Title 1, Section 109 of Tax Relief and Healthcare Act will be utilized by VBP programs for the measurement of performance and the calculation of incentive payments. vii. The VBP programs will undertake the responsibility of eliminating existing disparities in the health care system. The enforcement of the Value based purchasing programs would not be undertaken without the consent of the concerned medical personnel. viii. A withholding up to 2% of total payments pertaining to specific Medicare providers would be utilized in the evaluation of the incentive pool. All funds collected under the value based purchasing programs will be offered as incentive payments to the eligible participants will not be changed over time. (U.S. Department of Health and Human Services 2007). Models of VPB Programs: The value based purchasing programs are composed of three models which are listed as follows: Model 1: Single Large Purchaser: This involves a large active Medicare supplier which is working collaboratively with other suppliers. If reward incentives are targeted at these individuals then inevitably the overall performance of the health care system as a whole will ...
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The Medicare and Medicaid programs have been applied in the US in securing medical cover for patients. These programs are good and have been very influential in ensuring the health of people who cannot afford medical care. The US programs are however structured in a way that cuts on the scope of those who are considered eligible for the program.
The approach also helps in improving the existing strategies and operational framework in running of an organization (Nenita, n.d). Activity based management is an approach that uses the available information in a given organization to make more effective and efficient decisions.
Value Based Purchasing is a tool which aids in linking the national quality policy and lower cost goals. Value Based Purchasing is an exceptionally critical driver for revamping the manner in which services are paid. It links directly the payment to the quality of care offered to a patient.
The conditions make a patient to be degraded by the hospitals environment. The conditions are sometimes referred to as complications. An example of a Hospital-acquired condition is when a patient rolls and falls from the hospital bed. The result of the fall may be a broken hip.
Medicare coverage is not complete as it covers a portion of the cost of health care and the cost of long-term care (Social Security Online, 2010). This program is financially supported by payroll taxes which are paid by workers and employees and also by the monthly
To improve the quality of its service delivery, in 2007, the center for Medicare and Medicaid services (CMS) embarked on the program of Value Based Purchasing. This was one of the strategies employed by CMS to renovate its payment system to necessitate rewarding of
The aspects of services offered that are considered in the value-based purchasing program are clients’ experiences, hospital-acquired conditions, and the expected achievement of treatments given for specific diagnoses
dministers and also the works in corporation with national governments to administer the children’s Health insurance program (Allgov.com, 2014), Medicaid as well as the standards of the health insurance portability. Apart from these programs (Allgov.com, 2014), Centers for