The Affordable Care Act known as, Obamacare, is a reform which helps the healthcare system make healthcare affordable to everyone in their state without the high out of pocket expenses. Millions of Americans have gone into bankruptcy, because medical bills were expensive and unaffordable to pay back. Therefore, there are millions in population that don’t have health insurance or cannot afford to purchase health insurance, because of the high cost. Illnesses and diseases have begun to increase in population and the core morbidities were unable to be managed in the communities and hospitals spending more money to aggressively treat the diseases.
President Obama signed a plan where all health care can be affordable in America and Health Care cost can be reduced. There is multiple ways that health care can be reduced and affordable by managing disease processes and providing quality care.
The Hospital Value Based Purchasing (VBP) program rewards acute hospitals with incentive payments for quality care given to Medicare and Medicaid participants.
The Centers for Medicare and Medicaid services focuses each year on quality of care for beneficiaries. There are specific measures and criteria for each grouped domain. These measures are weighted according to percentages and then categorized into a benchmark which is the performance on a scale of 0-10. The baseline of quality care is given and evaluated each period to show the overall performance of the hospital. The evaluation results with the data found is processed to the national level where the state board evaluates and inspect the level of care given at the facility.
This is how the hospitals get their funding and reimbursements.
There are four components of VBP which identifies as safety, clinical care, efficiency, cost reduction and patient –caregiver experience of care/ care coordination.
Safety reduces adverse effects which results in harm of patient. Evidence base practice is aimed at most effective care with better outcomes. There will be times in which the hospital will have to change their process in order to obtain better outcomes and hospital stays. Physicians should provide information to patients and have a clear interest of the patient’s decisions of their health care, by providing the risks and benefits or alternatives as complied with the code of medical ethics Opinion Section 11.2.4. Nosocomial infections should be at a minimum while in the hospital. Tracking and measuring foleys, central lines, c-diff, MRSA management, anticoagulants, handling of needles, induced pregnancies, should be under surveillance to reduce infections and complications and harm to patients.
The high quality of care and low cost given at the hospital reduces readmission in which the hospital receives a penalty for readmissions.
VBP program uses clinical care to evaluate hospitals for inpatient acute care services on quality of care provided by the staff within a performance period. Clients with diagnosis of acute MI, HF, and PNA all have a mortality rate. The hospital will receive reimbursements or incentive payments if the diagnosis is managed with no rebound or delay in care. This allows the patient to have a better outcome. If the hospital fails to manage the disease process there is a penalty percentage deducted from the hospital. The hospital is responsible for the remainder of the cost for the patient’s hospital stay and care. This in return will decrease any pay raises for staff and budget cuts in the hospital. The star rating, incentive payments, and their avoidable cost are increased and quality of care reviews declines with lack of business. The State Board of Nursing or Joint Commission inspects the hospital in the quality of care given.
Value Based Purchase program uses Medicare/Medicaid spending per beneficiary for cost containment. CMS inspects individual practitioners, physicians to see if they are providing measures to manage the disease process efficiently. The rationale is to reimburse the practioner on the quality of care delivered, because care has been maintained at a low cost to Medicare and Medicaid. Continual management of the patient’s morbidity rate the better outcome of mortality rate and reduce readmission rate will decrease.
Nurses play an intricate role in informing practitoners of any change of condition in a patient. When a patient has a change in condition there is a certain amount of time in which the assessments had to be treated. Identifying early changes in patient’s conditions increases the chance of reducing high cost of treatment. Prevention is another way to reduce cost if patients have affordable health care to detect any diseases early before becoming exacerbated. The nurses has a tool called, “SBAR” to use if a patient has change of condition. It is a successful tool in communicating among doctors.
The SBAR allows the practitioner to identify the situation, background, assessment and recommendation to perform quality care for better outcome for the patient. Nurses are accountable for proper documentation in detail for the care that was given to the patient. In the nursing field quotes, “If it was not documented it was note done”. This can affect your reimbursements and impact on patient quality of care. The CMS needs to know what treatments were given in the patients care to managed their disease process. As nurses, we are the front lines of quality patient care. Nurses are responsible for teaching, assessing, educating, advocating, evaluation, planning implementing and having high quality of knowledge in the nursing field. This gains trust and respect for everyone that participates in the holistic care of the patient to obtain a good quality of health.
This program allows evaluation of the overall care given to the client. These evaluations can be used for ratings in quality care, improvement processes, reimbursements, evidenced base practice and communication. VBP program measures the patient’s outcome and hospital stay. Good quality care given can bring in revenue abundantly and increase your reimbursement which creates high morale for employees, pay raises, star ratings with rewards.
Everyone in the community is affected on how quality care is given, received and managed. Value Based Purchase Program as a whole can make health care affordable and the population can afford health care when quality and continuity of care is given. Proper guidelines and performances will decrease the cost of health care where it can be affordable and still have good quality of care. In managing the disease process, early detection is known to reduce the coat of healthcare and able to make affordable. The medical profession can make this change by engaging in using medical guidelines and prevention methods when managing patient’s plan of care.