Pneumococcal Vaccination and Value-Based Purchasing - Research Paper Example

? Pneumococcal Vaccination Topic Value-Based purchasing is a payment strategy that rewards the quality of health care production by paying incentives and having transparency in the healthcare system. Value in the healthcare industry can be considered as the production of quality, efficiency, cost effective and safe health care services. In Value-Based purchasing (VBP), the healthcare providers are held responsible for the provision of quality and the cost of the healthcare services to people. The system is rewarded and can suffer from the consequences of providing substantial health care services. Incentives are put so that they can be able to discourage unwanted and unnecessary expensive health care. VBP is a standardized system of healthcare provision that provides transparent, information and health status of the outcomes of patients. It makes sure that patients are satisfied with the services and that they are cost effective on the patients. VBP is a new type of healthcare provision system that has replaced the Medicare fee-for -service which was expensive and provided low quality health care to patients. VBP is expected to reduce the cost of offering healthcare services to 214billion dollars over the next ten years. This will mean that nearly three quarters of the FFS payment beneficiaries will benefit from the VBP (Stephen, 2009). CMS has got the crucial role to make sure that the Implementation of the quality improving strategies which include the pay for performance, care coordination programs, the patient safety programs, the e-prescription programs, the implementation of the EMR programs, public recording and measuring the performance of hospitals. All the states in America are willing to use these programs to provide quality healthcare services for their people and hence have healthy citizens. CMS is being given a chance to move from being a passive health care production group to becoming the most active buyer of healthcare which will be of high quality. CMS is supposed to hold back one percent of the DRG reimbursement that is paid to hospitals; this money will be given to the hospitals depending on how well they will score in their performance measures in the evaluations. CMS will be monitoring and evaluating the how the program will impact the provision and quality of health care. This will be done so especially for the minority population which receives extremely low quality health care systems, the number of citizens which receives the best health care and hospitals that are performing the best in providing quality health care. Although these rules were complicated in nature, CMS has got the responsibility to clear them and ensure that everyone understands these rules for better provision of health care (Stephen, 2009). CMS will utilize the data in hospitals to calculate the performance of hospitals and award score in the range of 0 to 10. They will then use these scores to award hospitals on how well it performed. These hospitals will then be tracked to see how their performance. They will then be reimbursed according to their performance. CMS has plays a crucial role in the VBP program; some of this role are; to improve the clinical quality, to reduce the adverse event and at the same time improve their patient safety, they play a role in encouraging and motivating more patient centered health care provision, they play a role in ensuring that there is no using of unnecessary expenses in the delivery of their health care system, CMS has got the role of ensuring that investments are made in the healthcare system in a courteous manner, and ensure that the investments made are worthwhile, and they are to ensure that provision of health care is done in a transparent manner that will enable patients and consumers of the health care system appreciate the services being offered in the hospitals. Some of the patients were given the vaccine before they were discharged, and it was indicated. The vaccination is recommended for people over the age of sixty five because it prevents the pneumococcal bacterium and meningitis up 75 percent effectiveness. In America, today, the coverage of the vaccine is not optimal. Many hospitals recommend the screening of the inpatients and the hospitalization of the adult vaccination is underused. Below is a list of the national hospital inpatient quality measures PN-3a Blood cultures performed within twenty four hours before or after hospitalization of the patients. PN-3b Blood cultures are performed in the ICU department before the receiving the initial antibiotic in the hospital PN-61 the initial selection of the CAP antibiotic in an Immuno-competent patient PN-6a2 the initial selection of CAP antibiotic in Immuno-competent ICU patient PN-6b2 the initial selection of CAP antibiotic for the Immuno-competent non ICU patient The strategies that hospitals used to ensure compliance of these indicators were as followed; For PN-3a, the cases were run; this included the initial patient population and the transmission date processing flow. The hospitals did a chest x-ray test or the checking of the comfort measures only. For the PN-3b case, the number of pneumonia cases who had been to the ICU initially would be checked before being admitted in to the hospitals. The patients above the age of eighteen would have their blood sample collected as an emergency case. For the PN- 6 to the PN-6b cases, the patients would receive prior antibiotic regimens that are consistent with the guidelines between the twenty fours of the patients’ stay in hospitals. The patients suffering from pneumonia must be over the age of eighteen years old. The hospitals in the United States of America are composed of the non-profit, and for profit hospitals; there are hospitals that are used for teaching and those hospitals that are used for safety net. Some of these hospitals have in the past given more health care to people who are not insured than other hospitals. The financial effects of the health care reforms have affected several hospitals. The hospitals that are highly likely to reap huge from the health care reforms most are the hospitals that served people who were not insured previously. They are likely to increase their revenues this is because they will be getting a lot of uncompensated care that they have been giving these people. Analysis shows that Americans will produce more than 40 billion dollars in revenue to be used in hospitals by the year 2019. Many pilot models have been created for the payment models to be used in the health care systems that will help in raising revenues for the American hospitals under the new health reforms. Most hospitals are being urged to cut down on the development part and improve the quality of their health care services. The models that have been proposed include one that says that the rates of readmission to hospitals should be reduced. Even though; the budget for the hospitals is being reduced, they still remain the most profitable institutions. This is because they manage to keep their beds full and hence they are constantly admitting patients into the hospitals. This in turn, generates revenue for the hospitals at a constant rate (Sally, 2008). It is predicted that Medicare will be able to save up to 40 billion dollars, which is relative, to the baseline payments that have been predicted in 2019. This will be the results of limiting hospitals in the development sector and their annual updates. Hospitals will be given 20 billion dollars less in the Medicare revenues by the year 2019. A body is supposed t be established by 2014 that will oversee the allocation of revenue to hospitals. The same body will oversee the developments that will be done in various hospitals countrywide (Sally, 2008). The Medicare payment system will remain to make sure that the health care system runs properly. There are more changes that could give the hospitals more motivation to give the American citizens quality health care. These incentives will also reduce the population to be readmitted in to hospitals; hence, eliminating unnecessary readmissions. As from 2013, the Medicare systems will decrease the amount of payments to the hospitals that have got high rates of readmissions for three diseases including pneumonia. This will save 7 billion dollars in before 2019. On top of that, the law will put up a policy that will deny Medicare payments to treatments that will be associated with conditions that will be acquired from hospitals. Medicare will pass this on to Medicaid. This will in turn make sure that hospitals will come up with creative and innovative systems to reduce the levels of diseases that are acquired in hospitals. This will in turn improve the quality of health care in hospitals. the government has predicted that this policy will save the Medicare around 1.5 billion dollars every year. CMS will start a program that will see Medicare developing and evaluating the payments for inpatients in hospitals. This program will be extended to outpatient services, and the post acute health care services that will be done three days before admission. This will be done as a pilot, but on confirmation, it will be mandatory for every hospital to do it with a high level quality (Jack, 1997). Non profit hospitals will be eligible to give out services that will enable the community to get decent health care service. The services that will be offered must be of satisfactory quality, and to make sure that every person is served correctly. The Medicare policy will restrict these hospitals from overcharging patients and will ensure that the funds in these institutions are used in a transparent manner to provide the best health care (Jack, 1997). Hospitals will have to struggle and give quality health care services at a remarkably low price hence this will strain the resources of hospitals in several states. Hospitals will be evaluated, and they will be given funding according to how they will be evaluated in by considering performance and their level of health care services. Hospitals will also be given funds based on their reporting period of twelve months. At the moment, most hospitals are increasing their level of fraudulent debts and the levels of their charity care. Hospitals are seeing their operational margins being decreased this is being experienced by hospitals in some states. Around fifty percent of hospitals in the American states are trying to reduce their non operational funds. While, some hospitals are complaining that their capital access is being reduced gradually. These are the financial constraints that are being faced by hospitals in trying to implement the new health care policy. These constraints are projected to save Medicare over 40 billion dollars over the next ten year period. The fall of the income levels in hospitals is being done to be accountable and utilize the available funds in hospitals to enable the provision of quality care and that the levels of readmission in some diseases are being reduced. The Medicare reimbursement to hospitals will continue to reduce, and the central government is at the moment trying so hard to push hospitals to provide quality health care services to patients. HCAHPS is a survey that is being used alongside with the new health care policy to measure the patient satisfaction level with the quality of health care service that they received from given hospitals. Hospitals give adult patients of sane mind a questionnaire containing twenty seven questions and the patients are allowed to evaluate the services that they received from the hospital. This survey is necessary to the Medicare so that they can evaluate the service production of the hospital and then use this to decide on how many funds the hospital will be given (Feldman, 2011). The Fawcett Memorial Hospital in Charlotte, Florida and Englewood Community Hospital in Englewood, Florida, these are the two hospitals that I visited their website. I would choose the Fawcett Memorial Hospital. This because, Fawcett memorial hospital has got a lot of facilities than Englewood Community Hospital, it was ranked among the top nine performing hospitals in the country. VBP will save the government a lot of funds, and in turn, it will provide people with quality health care services. It will enable the federal and central government to be able to manage the quality level of care being provided in the country hence correct where there is a mistake. At the same time, VBP will disadvantage hospitals as they will have to strain in order for them to make substantial developments (Feldman, 2011). Value-Based Purchasing will make sure that the American citizens get quality medical services at a much lower cost than it has been in the past. VBP will ensure that there is constant evaluation of hospitals; hence many hospitals will not hesitate to keep up their standards and levels of offering quality services. VBP is such a favorable policy and should be implemented through completion. References Feldman, H. R. (2011). Nursing Leadership: A Concise Encyclopedia, Second Edition. Osaka: Springer Publishing Company. House, U. S. (2011). Value-Based Purchasing for Physicians Under Medicare: Hearing Before the Subcommittee on Health of the Committee on Ways and Means, U.S. House of Representatives, One Hundred Ninth Congress, First Session, July 21, 2005. Memphis, Tennessee: General Books. Jack A. Meyer, L. R. (1997). Theory and reality of value-based purchasing: lessons from the pioneers. Washington: U.S. Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research,. Sally A. Shumaker, J. K. (2008). The Handbook of Health Behavior Change. Osaka: Springer Publishing Company. Stephen L. Isaacs, D. C. (2009). To Improve Health and Health Care. Hoboken, New Jersey: John Wiley & Sons. Read More