U.S. Health Care Delivery System and Pay for Performance - Assignment Example

U.S. Health care Delivery System and Pay for Performance Statement of topic The U.S. Health care Delivery System is currently facing a series of challenges. Despite the efforts that have been made for increasing the system’s efficiency, still problems in regard to the system’s various aspects tend to appear. The introduction of a new policy, as suggested below, is expected to enhance the system’s performance, even in the long term. It is required though that certain terms are met, meaning especially the funds and the training necessary for the project’s completion. Brief overview of issue area One of the key features of the U.S. Health Care Delivery System is the P4P scheme, a scheme mostly promoted through the Patient Protection and Affordable Care Act of 2010. Despite the perspectives of the P4P scheme, his application was proved quite problematic, especially due to the lack of effective control mechanisms and the failures in meeting deadlines in regard to the policies incorporated in the Patient Protection and Affordable Care Act of 2010. A key challenge in regard to the development of P4P schemes has been the following one: the specific schemes are not accessible to all physicians (Casalino et al. 2007, p.406). At the same time, the quality of reporting in healthcare settings across the USA is rather low (Cromwell et al. 2011). The introduction of the Patient Protection and Affordable Care Act of 2010 has not helped to resolve these problems, mostly because of delays in the implementation of the Act’s provisions. It should be noted though that the Patient Protection and Affordable Care Act of 2010 has been the first legislative text aiming to use performance – based payment for supporting the increase of quality in regard to healthcare services provided across USA (National Conference of State Legislatures 2010, p.1). The specific Act has also helped healthcare practitioners ‘to provide timely and cost-effective care’ (National Conference of State Legislatures 2010, p.1), so that the efficiency of the Healthcare system is increased. In a research developed in 1999 it was made clear that the improvement of healthcare services in USA could significantly help to reduce death toll among patients hospitalized in the country’s healthcare settings, a fact which is made clear through the Table 1 presented below (National Conference of State Legislatures 2010, p.1). Table 1 – Shortfall in Care in US (Source: Woolf 1999, cited in National Conference of State Legislatures 2010, p.1) Overview of existing policy The decrease of costs and the improvement of quality have been two of the key targets for the initiators of the Patient Protection and Affordable Care Act of 2010, the legislative text on which the reform of the U.S. Health Care Delivery system has been based. Initially, the above Act was considered as appropriate for addressing all problems related to the U.S. Health Care Delivery system. However, gradually, it was made clear that the specific Act has important weaknesses especially in regard to the terms of its implementation (Cromwell et al. 2011, p.1). The key problem that the specific Act had to resolve was the transformation ‘of its rules into workable programs’ (Cromwell et al. 2011, p.1). Moreover, the Act included a series of provisions for securing the access of patients to private insurance programs and for promoting the participation of the state in insurance programs addressing specific parts of the population (Cromwell et al. 2011, p.1). Still, these plans have been introduced gradually, destroying part of their benefits (Cromwell et al. 2011, p.1). In any case, the Patient Protection and Affordable Care Act of 2010 was considered as an effective tool for promoting Pay for Performance (P4P), a scheme that has not been effectively established. The context of P4P scheme is described in the study of Cromwell et al. (2011). According to the above researchers, the P4P scheme focuses on ‘the provision of incentives to healthcare practitioners to enhance performance either by improving quality or by decreasing costs’ (Cromwell et al. 2011, p.6). In this context, the success of the Protection and Affordable Care Act of 2010 would be primarily evaluated by using the above two criteria. The promotion of P4P concept through the Protection and Affordable Care Act of 2010 has been highly based on the ‘Accountable Care Organizations (ACO) framework’ (Gold 2010, p.1). These organizations aim to ensure that healthcare providers are hold responsible for the quality of healthcare services they provide (Gold 2010, p.1). The rewarding of the relevant initiatives is considered as an important incentive for persuading healthcare providers to participate in the relevant plans (Gold 2010, p.1). Pros and cons of existing policy The existing policy, as promoted through the Protection and Affordable Care Act of 2010, has a series of advantages. At a first level, the particular policy helped to increase professionalism in the healthcare services sector. Indeed, by introducing the P4P scheme the above Act managed to increase the motivation of physicians in regard to their practice. In the past, lack of motivation has been considered as a key reason for low motivation and lack of professionalism of physicians across USA (Hendrickson 2008). At the same time, the existing policy has increased accountability in healthcare services. Before the introduction of the above Act, accountability in the particular industry has been at low levels, a fact that has been characterized as the industry’s most important problem (Gold 2010). As already noted earlier, a series of changes has been developed in regard to various aspects of current U.S. Health Care Delivery system. These changes aimed to increase the system’s efficiency, a target that has not been achieved. In the study of Shih et al (2008), emphasis is placed upon the system’s most important problems: fragmentation (p.1). It is explained that a fragmented healthcare system can lead to a series of important problems, including the worsening of quality of the services delivered and the promotion of high-cost interventions (Shih et al. 2008, p.1). In other words, fragmentation, as involved in the US Health Care Delivery system can result to the failure of the targets set by the P4P scheme, a scheme which is based, as already explained, on ‘the enhancement of performance either through the increase of quality or the decrease of costs’ (Cromwell et al. 2011, p.6). If neither of these criteria can apply, then the P4P scheme will be led to a failure. Other weaknesses of the existing policy has been the failure in meeting deadlines related to the implementation of its plans and the failure in promoting all its plans simultaneously (Cromwell et al. 2011). Propose new policy The proposed policy is based on a series of practices. These practices should be all used for reforming the current U.S. Health Care Delivery System. The suggested practices address issues that have been already highlighted in the literature. It should be noted though that the solutions given are differentiated from those suggested in the literature, aiming to offer a different perspective of the system’s reform. Also, effort is made so that these practices are feasible, taking into consideration the increased needs of people for healthcare services and the turbulences in the global economy. The first phase of the suggested policy would be the introduction of a mechanism for controlling the implementation of the P4P scheme, as promoted through the Patient Protection and Affordable Care Act of 2010. This mechanism could primarily ensure that incentives are given to healthcare practitioner for enhancing their performance. This mechanism would have the form of a Committee boards cited in each state and being responsible for the achievement of the above target, i.e. the provision of appropriate incentives to healthcare practitioners, at a state level. These boards would be supervised by the Department of Health and Human Services. The next phase of the policy would refer to the introduction of a ‘payment for treatment’ practice, instead of the ‘fee-for-service’ practice that it is currently used in healthcare settings across USA. The above practice would have the following characteristics: a) the major part of a treatment plan will be payable in advance, b) Healthcare settings would have to propose a discount if such payment is arranged; c) An alternative of payment in installments plan would exist, but only for those patients that cannot afford pay in advance the total cost of the treatment plan; d) The level of each installments would be negotiated between the healthcare provider and the patient, taking into consideration the financial status of the latter and the duration/ cost of the treatment involved. At the next level, the potential development of the P4P scheme in all healthcare services providers would be reviewed. Particular reference is made to Medicare and Medicaid services, where the fee-for-service payment system still applies (Medicare Payment Advisory Commission 2012). Finally, boards should be developed, at state levels, for reviewing the accountability of physicians participating in the P4P scheme. The phases of the suggested policy are presented in Graph 1 below. It is clear that all practices incorporated in the policy need to be promoted, even if not simultaneously, so that the benefits expected, as analyzed further below, are achieved. Graph 1 – Suggested policy Arguments or recommendations about why this policy should be adopted and what weaknesses in existing policy it addresses. The suggested policy would highly contribute in the improvement of the U.S. Health Care Delivery system. The particular policy incorporates a series of practices that can help the above system to become more effective. In order to understand the role of the suggested policy in the achievement of this target it would be necessary to review and evaluate each one of these practices. At a first level, reference should be made to the policy’s suggestions for reforming the existing payment system. According to the suggested policy, the new payment system is based on the idea of paying the major part of a treatment plan in advance. The existing payment framework, as incorporated in the U.S. Health Care Delivery system, is based on ‘the fee-for-service rule’ (Shih et al. 2008, p.1). However, this rule ‘promotes the system’s fragmentation’ (Shih et al. 2008, p.1). The suggested practice would help to face the above problem and control bureaucracy. Instead of having to make particular payment arrangement for each part of a treatment, the new practice would offer the chance to evaluate the cost of the whole treatment plan and make appropriate payment arrangements, in the form either of the reduction of the amount due, if the whole amount is paid, or of the introduction of installments which would be affordable for the patient. In this way, the establishment of this payment practice would benefit both the state and the patients. At this point, it should be made clear that the changes made on the U.S. Health Care Delivery system through the Patient Protection and Affordable Care Act of 2010 have not helped to limit the fragmentation caused because of the system’s payment options. In fact, the fee-for-service rule has remained unchanged. The improvements made on the US. Health Care Delivery system in regard to the costs of the services provided referred only to the introduction of a higher range of insurance programs and the limitation of administrative processes involved (Patient Protection and Affordable Care Act 2010). In this context, the suggested payment practice is considered as of significant value, helping to control deficiencies of the U.S. Health Care Delivery system. At the same time, the Patient Protection and Affordable Care Act 2010 has failed in facing effectively important problems such as the limitation of accountability of healthcare providers and the expansion of P4P schemes to all healthcare practitioners, as explained above. The suggested policy would help to address all issues that have not been covered through the Patient Protection and Affordable Care Act 2010 and which can negatively impact the quality of healthcare services provided across USA. References Casalino, L., Elster, A., Eisenberg, A., Lewis, E., Montgomery, J., & Ramos, D. (2007). Will Pay-For-Performance and Quality Reporting Affect Health Care Disparities? Health Affairs, 26(3): 405-414. Available at http://content.healthaffairs.org/content/26/3/w405.full.pdf+html Cromwell, J., Trisolini, M., Pope, G., Mitchell, J., & Greenwald, L. (2011). Pay for Performance in Health Care: Methods and Approaches. RTI Press. Available at http://www.rti.org/pubs/bk-0002-1103-mitchell.pdf Gold, M. (2010). Accountable Care Organizations: Will they deliver? Mathematica Policy Research Inc. Retrieved from http://www.mathematica-mpr.com/publications/pdfs/health/account_care_orgs_brief.pdf Hendrickson, M. (2008). Pay for Performance and Medical Professionalism. Quality in Management of Health Care, 17(1): 9-18. Retrieved from http://medprof.bjmu.edu.cn/xsqy/39_pay%20for%20the%20formance%20and%20MP.pdf Medicare Payment Advisory Commission. (2012). A report to the Congress. Retrieved from http://www.medpac.gov/documents/Jun12_EntireReport.pdf National Conference of State Legislatures. (2010). Performance based Healthcare Providers Payments. May 2011. Retrieved from http://www.ncsl.org/portals/1/documents/health/PERFORMANCE-BASED_PAY-2010.pdf Patient Protection and Affordable Care Act 2010. Shih, A., Davis, K., Schoenbaum, S., Gauthier, A., Nuzum, R., & McCarthy, D. (2008). Organizing the U.S. Health care Delivery System for High Performance. Commission on High Performance Health System. Retrieved from http://www.commonwealthfund.org/usr_doc/Shih_organizingushltcaredeliverysys_1155.pdf Read More