Summary of the Impact of New CMS Initiatives on Organization’s Revenue Structure
CMS plays a key role in providing direction to Healing Hands Hospital about its health care system and payments. The facility has benefited from the CMS promotion of quality health care and healthcare coverage (CMS, n.d.). Patients and health providers can make an informed decision concerning the best and effective care provisions that deliver high-value care. This ensures for provision of the right care at the right to patients. Medicare and Medicaid provide payment systems such as bundled payment model, pay-for-performance program, and shared saving to Healing Hands Hospital. Accountable care organization (ACO) and home patient-centered payment also taking high spending in an alternative payment program. CMS’s prevention and pay-per-performance systems promote quality care, integrated repository data establishment, and health information modernization. CMS also integrate drug plan, and health plan sponsors into one reimbursement system for health provision; hence, improve proper coordination of care (CMS, n.d.). The available new service delivery and payment methods include Primary Care First and Direct Contracting. The models aim to reduce medical costs while improving the quality of care.
Accountable Care Organization and Its Benefits
Accountable Care Organization (ACO) is a group of hospitals, doctors, and other health care professionals, who coordinate a Medicare patient’s high-quality care as an organized team (CMS, n.d.). Unnecessary service duplication and medical error prevention are avoided in chronic illnesses such as high cholesterol or high blood pressure under such coordinated patient care. ACO enables the patient to get better medical attention and at the right time. It also prevents patients from incurring unnecessary costs for tests or treatments. ACO enables appropriate sharing of patient information by the health providers team, eliminating unnecessary tests’ duplication and enhancing faster recovery. Such a coordinated delivery of health care is exampled by the medical home model’s method. Concepts and elements of ACO include physician leadership, effective integration of clinics and all participant’s true partnership; patients and physician’s voluntary participation; coordination among health providers across multiple care transitions through integrated information system at the care point; effective patients’ engagement incentives; implementation of ACO structure and payment system increment; the defined mechanism for payment distribution, quality benchmarks, and spending, and the relationship of the organization.
Episode-Based Payment Initiative and Its Benefits to Healing Hands Hospital.
Episode-based payments are also known as bundled payments. It came about with the hope of improving the care of patients while reducing Medicare costs. The payment model is designed to be an all-inclusive payment on-time made in respect of all health case participants such as physicians, nurses, hospitals (CMS, n.d.). It also compensates the costs of medical equipment, medications, post-care, and any related service offered towards an illness case at Healing Hands Hospital. The method of payment is based on the specific care episode and its cost projection. In the patients’ surgery episode, the participant such as a surgeon, physician, anesthesiologist, and the hosting hospital is reimbursed jointly by the payers such as Medicare and insurance company. Based on typical historical costs, a care episode-specific price is paid to the hospital and health providers jointly by the payers. The payment model rewards providers’ quantity of service. It aligns provider’s incentives and allows specialists and health settings to work smoothly together. Facilities that trigger a care episode, such as inpatient rehabilitation centers, group practices of physicians, faculty of skilled nurses, agencies of home health, and long-time patient’ care hospitals, are the initiators of Bundled Payment for Care Improvement (BPCI). Other advantages of BPCI to Healing Hands Hospital include: making payments and reimbursements easier; huge health providers incentives that are cost- conscience; up-to-date and good health providers incentives to control costs.
Reference
Centers for Medicare and Medicaid Services (CMS). (n.d.). Innovation models. Retrieved from https://innovation.cms.gov/initiatives/#views=models