accountability in healthcare
Instructions
Accountability in Healthcare
This accountability in healthcare assignment will be at least 1500 words. Address each bulleted item (topic) in detail including the questions that follow each bullet. There should be three (3) sections in your paper; one for each bullet below. Separate each section in your paper with a clear brief heading that allows your professor to know which bullet you are addressing in that section of your paper. Include a “Conclusion” section that summarizes all topics.
This week you will reflect upon accountability in healthcare and address the following questions:
- Briefly define an Accountable Care Organization (ACO) and how it impacts health care providers:
- How do ACOs differ from the health maintenance organizations (HMOs) of earlier years
- What role does health information technology (HIT) play in the newer models of care?
- What is the benefit of hospitals partnering with primary care providers?
- How does bundling payments contain healthcare costs?
- How does pay for performance (P4P) improve quality care?
- Briefly discuss the value-based purchasing program?
- How do value-based purchasing (VBP) programs affect reimbursement to hospitals?
- Who benefits the most from value-based reimbursement and why?
- How does the VBP program measure hospital performance?
Assignment Expectations
Length: 1500-2000 words in length
Structure: Include a title page and reference page in APA format. These do not count towards the minimal word amount for this assignment. Your essay must include an introduction and a conclusion.
References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two (2) scholarly sources are required for this assignment.
Format: Save your assignment as a Microsoft Word document (.doc or .docx).
SAMPLE STUDENT ANSWER
Accountability in Healthcare
Accountability is one of the significant issues in healthcare. Accountability involves processes and procedures by which healthcare professionals justify and take responsibility for all their decisions. Liang et al. (2017) argue that the concept of accountability has three vital components. The first component is the loci of accountability. In healthcare, there are at least 11 parties that can ensure accountability in the sector. The second component is the domains of accountability.
Healthcare professionals and other staff can be held accountable for six main activities: financial performance, professional competence, public health promotion, legal and ethical conduct, adequacy of access, and community benefit (Bonde et al., 2018). The last component is the procedures of accountability. The procedures of accountability include informal and formal methods of disseminating and evaluating compliance. The purpose of this assignment is to explain various models of accountability in healthcare, including accountable care organization (ACO), pay for performance (P4P), and value-based purchasing (VBP).
Accountable Care Organization and Its Impacts on Healthcare Providers
ACOs can be defined as groups of hospitals, doctors, and other healthcare providers voluntarily and provide high-quality and coordinated care to their patients in the Medicare program (Center for Medicare and Medicaid Services, 2021). This program aims to ensure that patients get the right care when needed while reducing the cost of care and preventing medical errors. ACOs impact healthcare providers by ensuring that they meet professional competencies. Healthcare providers must provide safe, timely, effective, efficient, patient-centered, and equitable care (Aragon et al., 2021).
Healthcare providers can meet the competency by working together through the ACO program. Another impact is that the ACO has improved communication among healthcare providers. One of the ways to provide quality and safe care is through effective communication among healthcare providers. ACO has allowed healthcare providers to effectively share data about their patients and thus improve care (Kaufman et al., 2019). Lastly, ACO has also improved accountability among healthcare providers. Health providers under ACO are less likely to make mistakes because other professionals will evaluate their work.
Differences Between ACOs and Health Maintenance Organizations (HMOs)
An HMO is an organization or network providing health insurance coverage for an annual or monthly fee. The HMO comprises a group of health insurance providers limiting medical coverage to care offered by physicians and other healthcare providers who have signed a contract with the program. Campbell III (2018) notes that HMO contracts reduce the premiums of medical covers because the physicians have the advantage of getting patients directed to them. ACOs and HMOs are many differences. One of the differences is that ACOs are not insurance companies, while HMOs are made of medical insurance organizations.
In other words, ACOs are made of healthcare providers, while HMOs are made of medical insurance companies. The second difference is that patients receiving care under ACOs can visit a physician of their choice. However, patients under HMOs can only get care services from assigned primary care physicians (PCP1). Lastly, in ACOs, patients do not require referrals to consult another provider, while those in HMOs must have referrals from their assigned PCPs.
The Role of health information technology (HIT) in the Newer Models of Care
Alotaibi and Federico (2017) argue that HIT has improved significantly improved healthcare delivery. The authors note that HIT has improved patient safety by reducing adverse drug reactions, medical errors and increasing healthcare professionals’ compliance with practice guidelines. Newer care models also rely on HIT. One of the roles of HIT on newer models is improving communication between the care providers (Ko et al., 2018). Through HIT, healthcare providers can collect, analyze, and share patient data with their partners.
ACOs partners can also communicate and discuss among each on how to improve patient care through HIT. Another role of HIT is improving healthcare professional-patient communication (Alotaibi & Federico, 2017). HIT can allow patients to send their information to their care providers easily and faster, thus improving the quality of care. The last role of HIT in newer models is data protection and storage. The newer models heavily rely on data to function properly. Therefore, the HIT has improved the efficiency and effectiveness of the newer models by ensuring proper data management.
The Benefits of Hospitals Partnering with Primary Care Providers
Primary care providers are vital when it comes to care delivery. Tobin Tyler (2017) argues that better understanding between primary care providers and hospitals can positively affect care delivery by reducing physician turnover and improving continuity of care. The partnership between the two can also improve the quality of care. Hospitals can manage acute episodes better when they have a healthy relationship with physicians, and this can improve the patient experience by reducing the lengths of stay.
Tobin Tyler (2017) notes that a healthy working environment can improve the performance of healthcare staff. The partnership between hospitals and primary care providers can ensure greater physician performance by promoting a healthy working environment. Partnering with hospitals can provide doctors financial stability when the economy is uncertain. Physicians who have contracts with hospitals have financial security and are less likely to leave the organization. Lastly, hospitals also benefit from the partnership by reducing physicians’ competition, improving their brand, and strengthening human resources.
Impact of Bundling Payments on Healthcare Costs
The CMS promoted Jubelt et al. (2017) report that bundled payment programs reduce the cost of care of Americans. The authors also note that healthcare providers must be accountable for the cost and quality of care delivered within their facilities under the program. Bundling payments contain healthcare costs by rewarding providers for providing care at a low cost than the budgeted amount. In other words, if a healthcare provider offers a care episode for less cost than the one planned, the provider will keep the extra funds. Bundle payment also reduces the cost of care by preventing healthcare providers from increasing the cost of their services.
According to Agarwal et al. (2020), providers under bundled payment can get financial penalties if they increase the cost of care episodes. Bundled payments also contain healthcare costs by preventing healthcare providers from offering unnecessary care services. Complications and readmissions can increase the cost of care. Thus, bundled payments can also reduce the cost of care by providing incentives to providers who avoid readmissions and complications.
Impact of Pay-for-Performance (P4P) in Quality of Care
P4P is a payment program where workers are paid based on their performance. This model is often used to provide guidelines detailing performance matrix that can lead to increased pay (Mendelson et al., 2017). In healthcare, P4P ties reimbursement to best practices, metric-driven outcomes, and patient satisfaction. In other words, P4P attaches financial disincentives or incentives to the performance of providers. This program has improved the quality of care in many ways. One of the ways in reducing the cost of care services.
Through the program, providers are often given incentives for providing care for less budget. This program increases the quality of care by reducing readmissions (Mendelson et al., 2017). Providers under the program will ensure fewer readmission rates by providing effective care to get better incentives. Lastly, the program also improves the quality of care by paying providers more to avoid medical errors. Providers who have avoided medical errors are likely to get better incentives under P4P.
Value-Based Purchasing Program (VBP)
The VBP is a program designed to reward acute care hospitals or providers for providing quality care in inpatient settings. The program uses the quality care provided to adjust payments to acute care hospitals under the Inpatient Prospective Payment System (IPPS) (Chee et al., 2016). The program was developed to hold acute healthcare providers and hospitals accountable for the quality of care. The CMS rewards hospitals under IPPS based on the quality of care and not the quantity. The program withholds the Medicare payments of hospitals by 2% as specified by law (Chee et al., 2016). It then uses the reductions to pay value-based incentive payments based on performance.
Impact of VBP Programs on Hospitals Reimbursements
Similar to other P4P programs, VBP also impacts reimbursement to hospitals. Lee et al. (2020) note that hospitals which score lower receive payment in terms of reimbursements. The authors also report that VBP is the only program among the P4P programs that increase the Medicare reimbursements for hospitals that score high and thus cause a neutral effect on the institutions; budget (Lee et al., 2020). The program also initiates penalties for hospitals that have increased the cost of care, which can impact hospital reimbursement. In other words, hospitals with low scores will receive fewer reimbursements.
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Beneficiaries of Value-Based Reimbursement
Both patients and healthcare providers benefit from the program. Healthcare providers benefit from the program by receiving more funds as reimbursement payments for scoring higher. They also benefit in that their reputation and image will improve when they perform well. CMS often recognizes hospitals that have provided quality care at affordable cost in public, which can work well for the image and publicity of the hospitals (Chee et al., 2016). However, patients are the most beneficiaries of the program. One of the reasons why patients benefit most is because the program reduces the cost of care (Lee et al., 2020). The program can reduce the cost of care by preventing healthcare providers from offering unnecessary care services.
The program also reduces the cost of care by penalizing hospitals that increase the cost of their services. The second reason is that the program reduces medical errors and complications. The program aims to ensure that patients receive care that is free of medical errors or any complications. Chee et al. (2016) note that reducing medical errors and complications are also a way to relieve the healthcare cost burden on Americans. Third, patients benefit more because the program aims to improve their experience when they receive care. Fourth, the program benefits patients by ensuring their safety and preventing them from experiencing hospital-acquired infections.
How VBR Measures Performance
The VBR uses five matrixes to measure the performance of hospitals. The first metric is patient experience. Hospitals often score higher when their patients report positive patient experiences after they receive care. The second metric is patient safety. Hospitals that provide care free of adverse events and medical errors often receive higher scores (Lee et al., 2020). The third measure is complications and mortality. Hospitals that have recorded how patient mortality rate and incidences of complications during treatment also receive a higher score.
The cost of care and efficiency are also used to measure performance (CMS, 2020). Hospitals that have provided high-quality and effective care at low cost receive higher reimbursement. The last measure is healthcare-associated infections (CMS, 2020). The hospitals earn two points on each matrix, one for improvement and another one for achievement.
Conclusion
As discussed in the paper, accountability is so important in the healthcare sector. Healthcare agencies, such as the CSM, have developed various models to ensure accountability in the discipline. The models include the ACOs, P4P, and VBP programs. The goal of all these programs is to reduce the cost of care and improve quality. For instance, ACOs provide cost-effective and quality care by allowing healthcare providers to work together when offering care services.
The P4P model ensures cost-effective care by paying providers for providing quality care at an affordable cost. VBP is one of the P4P programs used in the US healthcare system. VBP measures performance using five matrices: patient experience, patient safety, mortality and complications, cost reduction and efficiency, and healthcare-associated infections.
References
Agarwal, R., Liao, J. M., Gupta, A., & Navathe, A. S. (2020). The impact of bundled payment on health care spending, utilization, and quality: A systematic review: A systematic review of the impact on spending, utilization, and quality outcomes from three Centers for Medicare and Medicaid Services bundled payment programs. Health Affairs, 39(1), 50-57. https://doi.org/10.1377/hlthaff.2019.00784
Alotaibi, Y. K., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal, 38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631
Aragon, L., Schieman, K., & Cure, L. (2021). Incorporating the six aims for quality in the analysis of trauma care. Health Systems, 1-11. https://doi.org/10.1080/20476965.2021.1906763
Bonde, M., Bossen, C., & Danholt, P. (2018). Translating value‐based health care: an experiment into healthcare governance and dialogical accountability. Sociology of Health & Illness, 40(7), 1113-1126. https://doi.org/10.1111/1467-9566.12745
Campbell III, W. W. (2018). A comparison of quality indicators between medicare accountable care organizations and health maintenance organizations using publicly available data. https://doi.org/10.25772/Z33Q-EK18
Center for Medicare and Medicaid Services. (2021). Accountable care organizations (ACOs). https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO
Center for Medicare and Medicaid Services. (2021). The hospital value-based purchasing (VBP) program. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HVBP/Hospital-Value-Based-Purchasing
Chee, T. T., Ryan, A. M., Wasfy, J. H., & Borden, W. B. (2016). Current state of value-based purchasing programs. Circulation, 133(22), 2197-2205. https://doi.org/10.1161/CIRCULATIONAHA.115.010268
Jubelt, L. E., Goldfeld, K. S., Blecker, S. B., Chung, W. Y., Bendo, J. A., Bosco, J. A., … & Horwitz, L. I. (2017). Early lessons on bundled payment at an academic medical center. The Journal of the American Academy of Orthopaedic Surgeons, 25(9), 654. https://dx.doi.org/10.5435%2FJAAOS-D-16-00626
Kaufman, B. G., Spivack, B. S., Stearns, S. C., Song, P. H., & O’Brien, E. C. (2019). Impact of Accountable care organizations on utilization, care, and outcomes: A systematic review. Medical Care Research and Review: MCRR, 76(3), 255–290. https://doi.org/10.1177/1077558717745916
Ko, M., Wagner, L., & Spetz, J. (2018). Nursing home implementation of health information technology: Review of the literature finds inadequate investment in preparation, infrastructure, and training. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 55, 0046958018778902. https://doi.org/10.1177%2F0046958018778902
Lee, S. J., Venkataraman, S., Heim, G. R., Roth, A. V., & Chilingerian, J. (2020). Impact of the value‐based purchasing program on hospital operations outcomes: An econometric analysis. Journal of Operations Management, 66(1-2), 151-175. https://doi.org/10.1002/joom.1057
Liang, X., Shetty, S., Zhao, J., Bowden, D., Li, D., & Liu, J. (2017). Towards decentralized accountability and self-sovereignty in healthcare systems. In International Conference On Information and Communications Security (pp. 387-398). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-319-89500-0_34
Mendelson, A., Kondo, K., Damberg, C., Low, A., Motúapuaka, M., Freeman, M., … & Kansagara, D. (2017). The effects of pay-for-performance programs on health, health care use, and processes of care: A systematic review. Annals of Internal Medicine, 166(5), 341-353. https://doi.org/10.7326/M16-1881
Tobin Tyler E. (2017). Medical-legal partnership in primary care: Moving upstream in the clinic. American Journal Of Lifestyle Medicine, 13(3), 282–291. https://doi.org/10.1177/1559827617698417
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