HSA4140_MOD2_Guilefuss
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Feb 20, 2024
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TRANSFER FROM FEE-FOR-SERVICE TO VALUE-BASED SYSTEM
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Transfer from Fee-For-Service to Value-Based-System
Leah Guilefuss
St. Petersburg College HSA4140 Strategic Management and Planning for Health & Human Services
Professor Justin Hancock January 28, 2024
TRANSFER FROM FEE-FOR-SERVICE TO VALUE- BASED SYSTEM
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Transfer from Fee-for-Service to Value-Based System Many healthcare organizations operate on a fee-for-service system, and many are also trying to implement changes and create a value-based system. Fee-for-service started back in the late 1970s and is still implemented today. As for value-based systems that didn’t start to be implemented till 2010 and on (Harris, 2017). Fee-for-service is where
healthcare professionals are paid per patient, per visit and for every service they are charged separately for as well (Lockner, 2018)
.
A value-based system is where they reward health care providers with incentive
payments for the quality of care they give, and it all started with CMS (
CMS’ Value-Based Programs | CMS
, n.d.). However, there are three programs that healthcare organizations can incorporate into there plan for shifting into value-based system such as the hospital value-based purchasing program (VBP), accountable care organization, and bundled payment/episode-of-care
model.
Hospital Value-Based Purchasing Program (VBP)
This program rewards acute care hospitals with incentive payments for the quality care provided within the inpatient hospital setting (
CMS’ Value-Based Programs | CMS
, n.d.). This program would be a great start to transitioning to value-based systems. With this program it is supposed to have better quality of care for patients and make their hospitals a much better experience. Most inpatient stays are elderly, which this program is geared toward Medicare patients. This program works by using the estimated total amount of the reductions to give funds to the value-based incentives for the hospital based on the performance in the program (
CMS’ Value-Based Programs | CMS
, n.d.). Incorporating this program would improve the quality of
TRANSFER FROM FEE-FOR-SERVICE TO VALUE- BASED SYSTEM
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care, the effectiveness of the medical staff, patient experience and safety of the Medicare patients. Accountable Care Organizations (ACO)
This service is provided by clinicians, hospitals and other health care professionals that come together under their own discretion to give coordinated high-quality care to a group of patients (
Accountable Care Organizations | AHA
, n.d.). Accountable care organizations are both private and public, but they are also contracted with Medicare. This service would be great to implement in the transition, because the ACO’s are very focused on providing and optimizing the
quality of care to patients. The accountable care organization uses data and EBP (evidence-based practice) which helps reduce duplicate care, coordinates services of care, helps close the gaps in patient care these all help reduce the costs of healthcare dollars (HealthPayerIntelligence, 2017). This service would help all healthcare organizations reduce costs by rewarding them with value instead of volume. Bundled Payment/Episode-of-Care Model
This model is designed for providers to be paid for “per episode” basis Lockner (2018). This means that it will include all necessary services including inpatient and outpatient, and all required services necessary to treat the patient Lockner (2018). This will cover the time of diagnosis to recovery. It’s one single cost, and the payment is based on the average cost of the “episode”, which will then make the providers profit by keeping it below the bundled rate Lockner (2018). Putting this into the plan for transition into value-based system would be a big change but provide the quality of care, and make the patients feel more valued with care. For the
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TRANSFER FROM FEE-FOR-SERVICE TO VALUE- BASED SYSTEM
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providers this approach would give them incentive to provide and collaborate care across the board, deliver high-quality care, and at low-cost health care. Conclusion Fee-for-service has been around for many years, so the transition will be challenging, but with these three programs/services there is a better opportunity for a smooth transition. Not all programs/services are on the same page, but with different approaches it easier for providers and organizations to transition.
TRANSFER FROM FEE-FOR-SERVICE TO VALUE- BASED SYSTEM
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References
Accountable Care Organizations | AHA
. (n.d.). American Hospital Association. https://www.aha.org/accountable-care-organizations-acos/accountable-care-organizations
CMS’ Value-Based Programs | CMS
. (n.d.). https://www.cms.gov/medicare/quality/value-based-
programs
Harris, J. (2017). Healthcare strategic planning
. ACHE Management.
HealthPayerIntelligence. (2017, May 24). Understanding the basics of accountable care organizations
. https://healthpayerintelligence.com/news/understanding-the-basics-of-
accountable-care-organizations
Lockner, A. M. (2018, September 26). INSIGHT: The Healthcare Industry’s Shift from Fee-for-
Service to Value-Based Reimbursement. Bloomberg Law
. Retrieved January 28, 2024, from https://news.bloomberglaw.com/health-law-and-business/insight-the-healthcare-
industrys-shift-from-fee-for-service-to-value-based-reimbursement
TRANSFER FROM FEE-FOR-SERVICE TO VALUE- BASED SYSTEM
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Health Services Administration Assignment Grading Rubric
Component:
Content Unacceptable Marginally Meets
Expectations
Meets
Expectations
Exceeds Expectations
Maximum
Points
Points
Earned
Demonstrates accurate understanding and synthesis
of assignment concepts by:
Meeting content standards
Identifying relevant points
and main ideas that are organized and complete
Providing accurate and relevant information highlighting an understanding of material
Demonstrating original thought and personal reflection in relation to the
concepts
Providing evidence to support thoughts, comments and opinions (e.g., source citations)
Content does not meet assignment standards
Information provided was inaccurate
Information presented in disorganized manner
Information presented in an incomplete manner
Demonstrates limited understanding of the material
No supportive evidence provided
Provides insufficient peer-reviewed resources (citations and references)
Demonstrates limited or no original thought and/or reflection
Content marginally meets assignment standards
Information presented
was generally accurate
Information presented
is minimally developed
Content presented in a
disorganized manner
Information presented
demonstrates only partial understanding of the material
Information is insufficiently supported with up-to-
date, peer-reviewed resources
Demonstrates some original thought and/or reflection
Content sufficiently meets all assignment
standards
Information presented is accurate
Information presented is adequately developed
Content presented is organized
Information presented demonstrates an adequate understanding of the
material
Information is adequately supported with up-
to-date, peer reviewed resources
Demonstrates original thought and reflection
Content exceeds all assignment standards
Information presented exceeds expectations of upper division course work
Information presented is well developed
Content presented is exceptionally well organized and comprehensive
Information presented demonstrates thorough understanding and application of the material
Information is thoroughly supported with up-to-date, peer reviewed resources
Demonstrates original thought and insightful connections
14
Component:
Professionalism
Unacceptable
Marginally Meets
Expectations
Meets Expectations
Exceeds Expectations
Maximum
Points
Points
Earned
Demonstrates a commitment to academic integrity and professional standards by:
Meeting all assignment requirements completely
Maintaining academic integrity
Applying instructor feedback, when appropriate
Submitting work that is accurate and reflective of upper level scholarly expectations
Using professional language and terminology
Submitting work on time
Assignment requirements were not met
Did not adhere to principles of academic integrity
Work does not reflect correction of errors previously noted by instructor
Excessive errors in grammar, spelling, punctuation, and/or APA
Excessive use of unprofessional language, terminology or abbreviations (i.e. texting)
Key requirements of the assignment were missing
Adhered to principles of academic integrity
Works reflects only minimal correction of
errors previously noted by instructor
Numerous errors in grammar, spelling, punctuation, and/or APA
Some use of unprofessional language, terminology or abbreviations (i.e. texting)
Key requirements of the assignment were met
Adhered to principles of academic integrity
Works reflects correction of the majority of errors previously noted by instructor
Minimal errors in grammar, spelling, punctuation, and/or APA
Language and terminology is professional and appropriate
Key requirements of the assignment were met
Adhered to principles of academic integrity
Works reflects correction of all errors previously noted by instructor
Accuracy with grammar,
spelling, punctuation, and/or APA
Exceptional use of professional language and terminology
6
Total Points
20
Instructor
Feedback
Special Disclaimers:
1 point deduction for failure to use standard HSA file naming convention: course_assignment_lastname
(i.e. HSA3104_timeline_smith)
1 point deduction for failure to include the assignment rubric.
Abbreviated Late HSA Policy, please see your course syllabus for the full late policy:
Assignments submitted within 24 hours of due date –
50% deduction (graded score – 50%).
Assignments submitted after 24 hours are not accepted for credit.
Academic Integrity:
All academic work submitted to satisfy course requirements is expected to be the student’s OWN work. All instances of plagiarism
will be
forwarded to the Dean for review and possible academic discipline.
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