Discussion: Organizational Policies and Practices to Support Healthcare Issues
Discussion: Organizational Policies and Practices to Support Healthcare Issues
Research has depicted that the high cost and low quality of health in America upshots from how healthcare carers are paid. This is the reason for the urgent need for significant changes to be made to address the way healthcare providers are paid for services delivered to cut costs and enhance quality and access to healthcare. Hence, the formation of health payment reform to address issues in healthcare payment systems. However, up to organizations are struggling to base the physician payments on the quality or value of care. This is as a result of the existence of many competing needs of the workforce, resources, and patients. The requirements pose a significant impact on the creation of policies intended to address the payment issue, as explained below.
How competing needs impact the development of policies
Research depicts that the development of policies that are meant to address the payment reform issues faces so many challenges that arise from the varying competing needs of providers, patients, and resources. The patients, for instance, require receiving reduced cost but quality healthcare services (McClellan et al., 2017). This has led to the formation of the Hospital-Acquired Condition Reduction Program (HACRP) policy program, which focuses on the financial penalization of hospitals that continue to have poor patient outcomes. On the other hand, in order to encourage the providers and hospitals to focus on quality care, organizations have embarked on policies that utilize value-based purchasing, VBP, or the pay for performance model in an attempt to connect the payment to quality directly (“Center for Medicare and Medicaid Services,” 2019). The model is meant to give incentive payments to providers who meet certain preset quality and patient satisfaction results.
Physician compensation and its impact
The health care payment reform requires health organization payment systems to change to compensation value rather than volume. This requires individual physicians and other healthcare experts’ compensation scheme to change as well to align with the framework of the new payment system, rather than with fee-for-service payment. Meaning, rather than mainly basing compensation on “productivity,” physicians will need to be compensated founded on factors such as teamwork, overall cost-effectiveness, and quality, which will ascertain the provider organization’s success under the health payment reform (Miller 2014). This focus on the provider resembles the existing fee-for-service compensation model. The present administrative burden of the reform diverts the care providers’ resources and time that could be better deployed on patient care as much as they are followed with massive incentives. This has little impact on care improvement or on patients’ assistance, and it affects hospitalized patients, and most of them fail to appreciate the goals and intentions of the healthcare payment reform (McClellan et al., 2017). Meaning, failure to clearly distinguish the cost and reimbursement of alternative treatments, providers, and health strategies obscure the care signals to consumers.
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A successful health payment system reform requires being more attractive for healthcare providers than the ancient fee-for-service payment system as it reduces costs for payers and improves quality for patients. Policies can address this competing patient and provider needs by replacing the fee-for-service payment completely with new payment systems that meet better the providers’ and patient’s needs (Miller, 2012). The new payment systems should provide greater flexibility on the best amalgamation of services for the patient. They should also offer accountability to ascertain that the combined costs of the services provided are less than the payment amount. An example of such payment systems includes “Episode-of-care” payments (Miller, 2014). These payment systems give providers a mortgage that covers the costs connected with all of the care a patient requires for a particular condition or procedure.
Conclusion
The healthcare payment reform is marking the United States’ most significant healthcare milestone. However, failure to clearly distinguish the cost and reimbursement of alternative treatments, providers, and health strategies obscures the care signals to consumers. Meaning careful consideration should be made to what extent physicians should participate in administrative issues to spare more time for the provision of clinical services.
References
Miller, H. D. (2014). Win-win-win approaches to healthcare cost control through physician-led payment reform. Clinical Gastroenterology and Hepatology, 12(3), 355-358.
Miller, H. (2012). Ten barriers to healthcare payment reform and how to overcome them. Published December, www. chqpr. org/downloads/overcomingbarrierstopay mentreform. pdf.
Center for Medicare and Medicaid Services. (2019, December 18). The skilled nursing facility value-based purchasing (SNF VBP) program. Retrieved from https://www.cms.gov
McClellan, M. B., Feinberg, D. T., Bach, P. B., Chew, P., Conway, P., Leschly, N., … & Teeter, D. (2017). Payment reform for better value and medical innovation. NAM Perspectives.