How is the Affordable Care Act improving health care?
That’s why the Affordable Care Act has been so crucial to tackling these and other challenges and increasing the quality of health care for Americans. Here’s how this landmark law is improving health care for you: You are healthier after a hospital stay.
What are the new Medicare payment policies?
Among the newest Medicare payment policies are those that move practitioner compensation from traditional fee-for-service models to bundled payments and other incentives for care teams to coordinate care across organizations and settings.
What is the role of pay-for-performance in healthcare cost control?
Developing an appropriate balance between cost-control or cost-containment and quality: Though initially promoted as a quality improvement tool, pay-for-performance is increasingly discussed as a tool for cost-containment. [13] Many health care plans believe rising health care costs are the result of over-utilization.
What is Medicare doing to improve patient dignity and safety?
Medicare is also working to improve patient dignity and safety through their Medicare Health Support pilot project, which provides chronically ill patients with health coaches help them manage their condition and keep up communication and coordination with their providers.
Which program identifies and reduces improper Medicare payments resulting in a reduction in the Medicare payment error rate?
The CERT program measures the improper payment rate in the Medicare Fee-for -Service (FFS) program. The CERT program reviews a statistically valid stratified random sample of all Medicare FFS claims to determine if they were paid properly under Medicare coverage, coding, and payment rules.
Which program measures monitors and reduces the incidence of Medicare fee-for-service?
Stack #552582QuestionAnswerAssess and measure improper Medicare fee-for-service payments.Comprehensive Error Rate TestingMeasure, monitor, and reduce the incidence of fee-for-service payment errors for short-term acute care.Hospital Payment Monitoring ProgramData analysis tool for specific CMS target areas.FATHOM28 more rows
Which program measures monitors and reduces the incidence of Medicare fee-for-service payment errors for short-term acute care inpatient PPS hospitals quizlet?
(The Hospital IQR program was previously called the Reporting Hospital Quality Data for Annual Payment Update program.) measures, monitors, and reduces the incidence of Medicare fee for-service payment errors for short-term, acute care,inpatient PPS hospitals.
What is the aim of the hospital readmissions reduction program Hrrp quizlet?
The Hospital Readmissions Reduction Program (HRRP) is a Medicare value-based purchasing program that reduces payments to hospitals with excess readmissions. The program supports the national goal of improving healthcare for Americans by linking payment to the quality of hospital care.
Which measures monitors and reduces the incidence of Medicare fee for service payment errors for short term acute care inpatient PPS hospitals?
The CMS established the HPMP to measure, monitor, and reduce the incidence of improper PPS acute care inpatient Medicare payments.
Which programs provides financial incentives to hospitals for reducing unnecessary hospital readmissions for Medicare beneficiaries?
The Affordable Care Act (ACA) established the Hospital Readmission Reduction Program (HRRP) in 2012. Under this program, hospitals are financially penalized if they have higher than expected risk-standardized 30-day readmission rates for acute myocardial infarction, heart failure, and pneumonia.
Which is a Hospital payment Monitoring Program data analysis tool that provides administrative hospital and Statespecific?
FATHOM: First-Look Analysis Tool for Hospital Outlier Monitoring is a Microsoft Access application that allows CMS to provide each State with hospital-specific Medicare claims data statistics, which identify areas having high payment errors. These target area statistics serve as relative indicators of payment errors.
Which is a hospital payment monitoring program?
WHAT IS HPMP? The Hospital Payment Monitoring Program (HPMP) is a nationwide effort by the Centers for Medicare & Medicaid Services (CMS), an agency of the Department of Health and Human Services, to protect the Medicare Trust Fund by ensuring that Medicare pays for services that are reasonable and medically necessary.
Which government sponsored program provides health care services to members of the uniformed services and their families?
TRICARE is the health care program for uniformed service members, retirees, and their families around the world. TRICARE provides comprehensive coverage to all beneficiaries, including: Health plans.
What is CMS triple aim?
Improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care.
How does triple aim improve patient satisfaction?
TRIPLE AIM APPROACH The aim is to optimize health system performance in three ways by: improving the patient experience of care (including quality and patient satisfaction) improving the health of populations. reducing the per capita cost of health care.
How can you reduce the readmission rate?
Let's examine 7 strategies to reduce hospital readmissions:1) Understand Current Policy. ... 2) Identify Patients at High Risk for Readmission. ... 3) Utilize Medication Reconciliation. ... 4) Prevent Healthcare-Acquired Infections. ... 5) Optimize Utilization of Technology. ... 6) Improve Handoff Communication.More items...
What is an ACO in Medicare?
ACOs are defined by CMS as “groups of physicians, hospitals, and other health care providers who come together voluntarily to give high-quality coordinated care to the Medicare patients they serve” ( CMS, 2012c ). The goal of ACOs is to improve quality of care for Medicare beneficiaries by coordinating care among practice settings (e.g., hospitals, physician groups, and skilled nursing facilities), which helps ensure that patients get the appropriate level of care and that unnecessary duplication of services, medical errors, and hospital readmissions are reduced ( CMS, 2012c ). CMS has established two ACO payment programs to provide financial incentives for Medicare-enrolled providers who come together to form an ACO: the Medicare Shared Savings Program and the Advance Payment Model.
How much did Medicare spend on inpatient care in 2008?
In 2008, spending on hospital inpatient care came to $129.1 billion, or 29 percent of total Medicare payments that year. Despite such high spending, the quality of care was deemed not adequate for beneficiaries who had multiple chronic conditions and see multiple practitioners.
What is the NHSC?
10 This legislation authorized the U.S. Public Health Service to assign commissioned officers and federal civil service personnel to practice in shortage areas. In 1972, Congress passed the Emergency Health Personnel Amendments authorizing scholarships to support health professions education in return for a minimum of 2 years of service in shortage areas designated by the agency. During the 1980s, the NHSC implemented the Loan Repayment Program, which substantially increased the number of NHSC field personnel.
How does shared savings improve health care?
Shared savings is an approach to improving the value of health care by promoting accountability, requiring coordinated care, and encouraging infrastructure investments such as electronic health records and broadband to enable the secure exchange of clinical information across settings in real time ( CMS, 2012d ). Other investments may include hiring new nurse care managers and other personnel to provide better continuity of care across clinical settings. Participants agree to lower the cost of health care while meeting identified performance standards by sharing resources and care in a coordinated manner.
What is pioneer ACO?
The pioneer ACO model is designed to support organizations that already have experience operating as ACOs or in similar arrangements providing coordinated care to Medicare beneficiaries at a lower cost to Medicare. It is designed to allow them to move more rapidly from a shared savings payment model to a population-based payment model and to work in coordination with private payers to provide better care for beneficiaries ( CMS, 2012e ).
What are the challenges of managing the care of older adults with multiple chronic health conditions?
The growing costs of health care, the demographics of the aging population, and the challenges of managing the care of older adults with multiple chronic health conditions are driving system reform and innovations in health services delivery. Among these are changes intended to improve access to primary care services and to improve the coordination of care as mechanisms for improving access and health care outcomes.
What factors affect practitioner compensation?
At the same time, factors that affect practitioner compensation, including payment policies of the Medicare program, may also have had an effect on the health care workforce’s ability to provide acceptable access in different geographic areas.
What are the factors that prevent many Americans from receiving the highest standards of care?
They include: The slow pace with which new technology, information and guidelines are adopted by the health care industry.
Who is responsible for investigating and resolving Medicare quality of care complaints?
As part of its overall mission to improve the quality of health care for Medicare beneficiaries, the Social Security Act places the responsibility for investigating and resolving “quality of care” complaints from Medicare beneficiaries with the QIOs.
Why is quality of care important?
However, its importance as an advocacy tool for obtaining and maintaining services is often less obvious . Such issues are integral to understanding who receives care, the promptness and appropriateness of care, and to understanding systemically the reasons why quality and access problems occur. A focus on quality allows beneficiaries and their advocates to participate in the development of appropriate monitoring and enforcement of quality standards. The Center for Medicare Advocacy focuses on quality not only to raise general consumer awareness of this important topic, but to highlight the use of this growing body of knowledge by advocates to secure and expand services. Racial and ethnic minority populations and the larger disabled community should pay particular attention to these issues because these groups tend to be less supported by the health care community.
What can a beneficiary do if he or she believes that the medical care that the doctor prescribed was inadequate or
What can a beneficiary do if he or she believes that the medical care that the doctor prescribed was inadequate or incorrect in some way? In Medicare, beneficiaries may request a “quality of care review” and question the level or kind of services provided by their practitioner or provider.
What are the barriers to quality of care?
These include: Entry into the Health care system; the accessibility of care. Structural Barriers; the ease of navigating through the system to receive the best care.
What is slow pace in healthcare?
The slow pace with which new technology, information and guidelines are adopted by the health care industry. Current and historical lack of government incentives, standards, or direction. Inconsistent care by physicians and other health care professionals.
Why do people not receive health care?
There are many people who do not receive quality care because of their race, ethnicity, gender, socio-economic status, age or health status. As evidenced in the current national debates over universal health care, not everyone has insurance, or access to health care.
What is the purpose of healthcare financial management?
The purpose of healthcare financial management is to. provide accounting and financial information that assists the manager in achieving the organizations purpose.
What are the four types of ratios used in financial analysis?
The four types of ratios used in financial analysis are. liquidity, profitability, activity, and capital structure.
Why is the Affordable Care Act important?
That’s why the Affordable Care Act has been so crucial to tackling these and other challenges and increasing the quality of health care for Americans. Here’s how this landmark law is improving health care for you: You are healthier after a hospital stay. Thanks in part to the Affordable Care Act, health care quality is improving quickly.
How much will the US spend on health care in 2020?
Already, projected federal spending on health care has been slashed by $200 billion in 2020, thanks largely to slower health care cost growth. That means lower deficits, more room for investment in education, roads, bridges, or lower taxes. But there’s more work to do to make sure every American receives the highest-quality health care they can ...
What is Medicare Star Rating?
And Medicare is creating “star ratings” for health plans and many types of health care providers – improving performance and information for patients. You get more time with your doctor when you need it. New care models – called “primary care medical homes,” or “accountable care organizations” – provide support for health care when patients need it.
