M4-340 Response

Response Posts: When responding to at least two of your peers, consider the following:

· In what other ways does the initiative reviewed by your peer improve healthcare?

· How is the initiative reviewed by your peer different from or similar to the initiative you discussed?

· What other strategies might be used to address the gap?

Peer 1-AV

The Promoting Interoperability Program was created by Centers for Medicare and Medicaid (CMS) in 2011, formerly known as the Medicare and Medicaid EHR Incentive Program. This program was created to encourage eligible hospitals and critical access hospitals (CAH) to demonstrate meaningful use of certified electronic health record technology (CEHRT). For 2021, Medicare is requiring that eligible hospitals and CAHs show a 90 day reporting period and to report on one of four measures including; Electronic prescribing, Health information exchange, Provider to Patient exchange, or  Public Health and Clinical Data Exchange. As for Medicaid, requirements differ slightly within this program. Eligible professionals document quality measures that are directly related to their scope of practice (CMS, 2021).

I am an Occupational Therapy Assistant and the Director of Rehabilitation at a Retirement Community (now called Life-Plan communities) and in June of this year the Administration staff received emails from the CEO reporting that as part of the new Interoperability requirement from the Department of Health and CMS, our campus had partnered with Health Share Exchange in order to connect with the NJHIE via Point Click Care (the system all departments use for documentation on residents). As per the CEO the levels of care that participate include skilled nursing and assisted living; however not the independent living residents. The process is for new admitting residents to sign a paper with their approval or denial for their health information to be a part of the health sharing network.

This program addresses the gap in health care of poor care coordination between providers and settings.  Care coordination is important for many reasons including; decreasing readmission rate to hospitals, improving continuity of care specifically when transitioning from various settings or providers, reducing duplication of services and therefore reducing health care costs. The health share exchange allows hospitals, physician offices and other facilities to view medical records and services, which is crucial for providing quality care. In terms of the Triple Aim, the initiative of Promoting Interoperability Programs will ultimately lower costs as stated above with reducing unnecessary or duplication of services, improving population health with care coordination that delivers appropriate treatment, and improving the patient experience with increased communication between providers.

 

Centers for Medicare and Medicaid Services. (2021). Medicare and Medicaid Promoting Interoperability

Program Basics.  https://www.cms.gov/Regulations-and-Guidance/ Legislation/

EHRIncentivePrograms /Basics

Peer 2-RW

Value-Based Purchasing Reform for Hospitals

Group C

           In an effort for compliance towards achieving health care reform and the basics of the Triple Aim Initiative, the Centers of Medicare & Medicaid Services, or CMS, implemented the Hospital Value-Based Purchasing Program (VBP) effective July 1, 2011, in accordance with section 1886 (o) and amended by the formerly known Affordable Care Act. (Federal Register, May 2011).  The reform program rewards hospitals for the quality of care they provide to the population they serve.  Under Medicare Part A (Hospital Insurance), inpatient hospital stay costs are based on set rates under the inpatient prospective payment system (IPPS).  Each case is sorted into a diagnosis-related group (DRG) and assigned a payment amount(weight) based on the average resources used to treat Medicare patients in that specific group.  In two states, Alaska and Hawaii, the base payment is adjusted to include the cost of living.  In other states, the base payment amount is adjusted by the national wage index according to the geographical location of the hospital.  This base payment rate is then multiplied by the DRG relative weight (CMS.gov, Acute Inpatient PPS, n.d.).   These are the DRG-related payments made to the hospital by Medicare /Medicaid to treat admitted patients.  Additional payments also include incentives and adjustments for teaching hospitals and those institutions serving low-income patients.

           As CMS reviews hospitals, they are evaluated by meeting or exceeding performance standards throughout the fiscal year.  In addition, Clinical Outcomes, Patient and Community Engagement, Safety measures, and Efficiency and Cost Reductions are given equal consideration and measure in each case.  The intent is to provide quality care and improve positive outcomes by reducing readmissions, adverse events, unnecessary procedures and improving patient and family understanding of treatment and post-care plans. 

      The primary purpose of the Value-Based Purchasing Reform Program is to associate hospital payments to improved performance by holding the hospital and health care providers in hospitals accountable for the costs and the quality of care that is given.  The hopes are designed to reduce the per capita cost of health care, one of the three dimensions of the Triple Aim Initiative.  

      As a medical assistant in primary care, we see patients prior to hospital admission or post-care following a hospital stay.  It is vital to our medical providers that continuity of care following our patients is observed for the best optimal outcome.  Patients seen in our office need guidance after a traumatic event, like a hospital admission.  To ensure complete transparency of care, we review with the patients what was done during their stay, the treatment plan moving forward, and seek to remove any confusion with patients and family members if that need arises.  As a healthcare office, we seek to fulfill another dimension of the Triple Aim Initiative but working in collaboration with hospitals and the Value-Based Purchasing Reform Program that evaluates them, ultimately, the goal for improving patient experience of care is the same.

 

References:

 Federal Register, Vol. 76, No. 88, May 6, 2011.  Retrieved from https://www.govinfo.gov/content/pkg/FR-2011-05-06/pdf/2011-10568.pdf

 CMS.gov, Acute Inpatient PPS, n.d.  Retrieved from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatient PPS