NCBI Bookshelf. A service of the National Library of Medicine,.docxvannagoforth
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Institute of Medicine (US) Roundtable on Value & Science-Driven Health Care; Yong PL, Olsen LA, McGinnis
JM, editors. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation.
Washington (DC): National Academies Press (US); 2010.
5 Approaches to Improving Value—Provider and Manufacturer
Payments
INTRODUCTION
Payment design, coverage policies, reimbursement rules, and other financial incentives and
disincentives are powerful motivators when attempting to steer the healthcare system toward
more desirable care patterns (Guterman et al., 2009). Experiments with payment design and
coverage and reimbursement policies are currently going on in both public and private healthcare
sectors, with varying results. Speakers in this session of the workshop explored current payment
design experiments and discussed the efficacy of utilizing these reimbursement tools to improve
the value received from health care.
In this chapter, Carolyn M. Clancy details the pay-for-performance (P4P) model, an effort to
more explicitly link provider payments to quality of care. She highlights the lack of coherent
approaches to P4P and the variable success this approach has had in fundamentally changing
provider practice patterns. For example, while financial incentives for individual physicians have
shown that P4P can induce quality improvements for diabetic patients (Beaulieu and Horrigan,
2005), group-level incentives have had no impact on mammography screening or hemoglobin A
testing rates (Rosenthal et al., 2005). After underscoring that the current incentive system and
healthcare infrastructure fail to accommodate the achievement of real efficiency and quality, she
outlines recommendations for rethinking medical training, measurement, system design, and the
reward system.
Building on Clancy’s recommendations, Donald A. Sawyer identifies how the current healthcare
system stymies innovation in product development. He suggests refocusing the myopic view of
innovation on the horizon of long-term health improvements and financial savings. Reed V.
Tuckson discusses the alignment of manufacturers, technologists, payers, patients, and providers
necessary to establish a system that continues to provide incentives for innovation and maintains
an open market for the development of promising but unproven interventions. He elaborates
specifically on a joint effort between UnitedHealth Group and the American College of
Cardiology to develop appropriateness criteria for cardiac single-photon emission computed
tomography myocardial perfusion imaging—a new and very expensive technology—based on
best evidence as an example of how the interests of diverse stakeholder groups could be aligned.
In conclusion, Steven D. Pearson likens coverage and reimbursement tools to a blunt knife that
lacks subtlety in effecting value improvements, bu ...
Top seven healthcare outcome measures of healthJosephMtonga1
The seven healthcare outcome measures are meant to understand the quality of health systems and how they could be measured and how quality care could be provided to clients.
ECO/561 Week 5 Assignment Rubric
Individual Assignment: Effectiveness of the Counter-Cyclical PoliciesPurpose of Assignment
This assignment addresses how both monetary and fiscal policies have been used during the so-called Great Recession, which began in December 2007 and ended in June 2009, to the present to moderate the business cycle. Resources Required
Tutorial help on Excel® and Word functions can be found on the Microsoft® Office website. There are also additional tutorials via the web offering support for Office products.Grading Guide
Content
Met
Partially Met
Not Met
Comments:
Selected an industry that suffered heavy losses during the Great Recession and produced an Excel® Workbook including the following data from December 2007 to the present:
· One dataset related to the U.S. housing industry such as housing starts, the FHFA housing price index, or another dataset of your choice related to the housing market.
· One dataset related to personal or household income or to personal or household saving.
· One dataset related to the labor market such as the unemployment rate, initial claims for unemployment insurance, or another dataset of your choice related to the U.S. labor force.
· One dataset related to production and business activity within the market or industry you choose to analyze.
15 points
Using data results analyzed the economic and sociological forces that drove the market equilibrium to unsustainable heights, commonly referred to as "bubbles," and the shocks that brought the markets back down.
10 points
Discussed specific changes in supply and demand within the markets and/or industries you chose to analyze.
10 points
Determined whether specialization of industry had any influence on the impact of the recession. 10 points
Examined prior government policies and legislation that might have exacerbated the impact of the shocks. Also, discuss government actions/regulations that might be undertaken, and/or have been undertaken, to moderate the effects of extreme economic fluctuations. 15 points
Evaluated the actions of the federal government (fiscal policy) and the Federal Reserve (monetary policy) to restore the economy and foster economic growth. Based your evaluation on information available at Internet sources such as, but not limited to, the Fed's The Economy Crisis and Response website as well as other appropriate sources found on the Internet and in the University Library. You did address the effectiveness of those counter-cyclical policies. 20 points
The analysis is a minimum of 1,050 words in length. 5 points
Total Available
Total Earned
85
#/85
Writing Guidelines
Met
Partially Met
Not Met
Comments:
The paper—including tables and graphs, headings, title page, and reference page—is consistent with APA formatting guidelines and meets course-level requirements. 10 points
Intellectual property is recognized with in-text citations and a reference page. 10 points
Paragraph and s ...
Running Head PERTINENT HEALTHCARE ISSUE1PERTINENT HEALTHCAR.docxtodd581
Running Head: PERTINENT HEALTHCARE ISSUE 1
PERTINENT HEALTHCARE ISSUE 2
Analysis of Pertinent Healthcare Issue
Students Name:
Institutional Affiliation:
Impact of increasing cost in a health organization
Introduction
The cost of receiving healthcare service is becoming a serious national healthcare concern. It has been established that the United States spend more on healthcare, in relation to the national income than any other industrialized nation. However, achieving minimum cost means having to make certain hard compromises which have never been easy. For example, low expenditure on research and development, limitation in terms of the choices of health coverage or healthcare providers and having to wait for long before using new technologies. The health system has gone through a series of transformational changes that has seen the cost of healthcare provision sky-rocket. The most affected are among the 41 million uninsured Americans who are unable to cater for the cost of insurance as well as the underinsured whose coverage program cannot cater for their overall health needs. The major catalyst behind the rising cost of healthcare has been; the rising number of aging population that take great benefit from the technologies created for lengthening life span, lifestyle choices like adoption of sedentary lifestyle and unhealthy eating habits resulting to obesity and cardiovascular disorders among others.
Cost impact on health organization.
Increasing cost has impacted the national health organization/system in so many ways. The impacts are not only experienced by the patients but the providers, employers, payers (insurance bodies) and even other employees within the health organization. Firstly, an array of transformational changes has been made i.e. payment transformation where a shift has been made from volume-based (fee-for service payment) which has high cost implications to value-based models and also the development of primary care in attempt to counter increasing cost. The turnover of healthcare providers has also faced a fair share of cost impact. The providers burdened by the feeling of denying patients services due to inability to cater for cost or lack of insurance loses meaning of services and morale to continue with the service. Consequently, advancement in training and education improve the providers’ patient service and more enhanced application of Evidence-Based practice appears costly and unaffiliated hence promoting low morale. Morbidity and mortality cases has been on the rise. Advanced technology used in diagnosis/treatment of serious medical conditions has become expensive and some of them are not covered by the insurance (core payments) hence late interventions taken after serious damage. The is also an indication of lowered patient engagement as far healthcare decision making is concerned since patients with financial challenge have limited options and are sometimes forced to comply with the physici.
NCBI Bookshelf. A service of the National Library of Medicine,.docxvannagoforth
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Institute of Medicine (US) Roundtable on Value & Science-Driven Health Care; Yong PL, Olsen LA, McGinnis
JM, editors. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation.
Washington (DC): National Academies Press (US); 2010.
5 Approaches to Improving Value—Provider and Manufacturer
Payments
INTRODUCTION
Payment design, coverage policies, reimbursement rules, and other financial incentives and
disincentives are powerful motivators when attempting to steer the healthcare system toward
more desirable care patterns (Guterman et al., 2009). Experiments with payment design and
coverage and reimbursement policies are currently going on in both public and private healthcare
sectors, with varying results. Speakers in this session of the workshop explored current payment
design experiments and discussed the efficacy of utilizing these reimbursement tools to improve
the value received from health care.
In this chapter, Carolyn M. Clancy details the pay-for-performance (P4P) model, an effort to
more explicitly link provider payments to quality of care. She highlights the lack of coherent
approaches to P4P and the variable success this approach has had in fundamentally changing
provider practice patterns. For example, while financial incentives for individual physicians have
shown that P4P can induce quality improvements for diabetic patients (Beaulieu and Horrigan,
2005), group-level incentives have had no impact on mammography screening or hemoglobin A
testing rates (Rosenthal et al., 2005). After underscoring that the current incentive system and
healthcare infrastructure fail to accommodate the achievement of real efficiency and quality, she
outlines recommendations for rethinking medical training, measurement, system design, and the
reward system.
Building on Clancy’s recommendations, Donald A. Sawyer identifies how the current healthcare
system stymies innovation in product development. He suggests refocusing the myopic view of
innovation on the horizon of long-term health improvements and financial savings. Reed V.
Tuckson discusses the alignment of manufacturers, technologists, payers, patients, and providers
necessary to establish a system that continues to provide incentives for innovation and maintains
an open market for the development of promising but unproven interventions. He elaborates
specifically on a joint effort between UnitedHealth Group and the American College of
Cardiology to develop appropriateness criteria for cardiac single-photon emission computed
tomography myocardial perfusion imaging—a new and very expensive technology—based on
best evidence as an example of how the interests of diverse stakeholder groups could be aligned.
In conclusion, Steven D. Pearson likens coverage and reimbursement tools to a blunt knife that
lacks subtlety in effecting value improvements, bu ...
Top seven healthcare outcome measures of healthJosephMtonga1
The seven healthcare outcome measures are meant to understand the quality of health systems and how they could be measured and how quality care could be provided to clients.
ECO/561 Week 5 Assignment Rubric
Individual Assignment: Effectiveness of the Counter-Cyclical PoliciesPurpose of Assignment
This assignment addresses how both monetary and fiscal policies have been used during the so-called Great Recession, which began in December 2007 and ended in June 2009, to the present to moderate the business cycle. Resources Required
Tutorial help on Excel® and Word functions can be found on the Microsoft® Office website. There are also additional tutorials via the web offering support for Office products.Grading Guide
Content
Met
Partially Met
Not Met
Comments:
Selected an industry that suffered heavy losses during the Great Recession and produced an Excel® Workbook including the following data from December 2007 to the present:
· One dataset related to the U.S. housing industry such as housing starts, the FHFA housing price index, or another dataset of your choice related to the housing market.
· One dataset related to personal or household income or to personal or household saving.
· One dataset related to the labor market such as the unemployment rate, initial claims for unemployment insurance, or another dataset of your choice related to the U.S. labor force.
· One dataset related to production and business activity within the market or industry you choose to analyze.
15 points
Using data results analyzed the economic and sociological forces that drove the market equilibrium to unsustainable heights, commonly referred to as "bubbles," and the shocks that brought the markets back down.
10 points
Discussed specific changes in supply and demand within the markets and/or industries you chose to analyze.
10 points
Determined whether specialization of industry had any influence on the impact of the recession. 10 points
Examined prior government policies and legislation that might have exacerbated the impact of the shocks. Also, discuss government actions/regulations that might be undertaken, and/or have been undertaken, to moderate the effects of extreme economic fluctuations. 15 points
Evaluated the actions of the federal government (fiscal policy) and the Federal Reserve (monetary policy) to restore the economy and foster economic growth. Based your evaluation on information available at Internet sources such as, but not limited to, the Fed's The Economy Crisis and Response website as well as other appropriate sources found on the Internet and in the University Library. You did address the effectiveness of those counter-cyclical policies. 20 points
The analysis is a minimum of 1,050 words in length. 5 points
Total Available
Total Earned
85
#/85
Writing Guidelines
Met
Partially Met
Not Met
Comments:
The paper—including tables and graphs, headings, title page, and reference page—is consistent with APA formatting guidelines and meets course-level requirements. 10 points
Intellectual property is recognized with in-text citations and a reference page. 10 points
Paragraph and s ...
Running Head PERTINENT HEALTHCARE ISSUE1PERTINENT HEALTHCAR.docxtodd581
Running Head: PERTINENT HEALTHCARE ISSUE 1
PERTINENT HEALTHCARE ISSUE 2
Analysis of Pertinent Healthcare Issue
Students Name:
Institutional Affiliation:
Impact of increasing cost in a health organization
Introduction
The cost of receiving healthcare service is becoming a serious national healthcare concern. It has been established that the United States spend more on healthcare, in relation to the national income than any other industrialized nation. However, achieving minimum cost means having to make certain hard compromises which have never been easy. For example, low expenditure on research and development, limitation in terms of the choices of health coverage or healthcare providers and having to wait for long before using new technologies. The health system has gone through a series of transformational changes that has seen the cost of healthcare provision sky-rocket. The most affected are among the 41 million uninsured Americans who are unable to cater for the cost of insurance as well as the underinsured whose coverage program cannot cater for their overall health needs. The major catalyst behind the rising cost of healthcare has been; the rising number of aging population that take great benefit from the technologies created for lengthening life span, lifestyle choices like adoption of sedentary lifestyle and unhealthy eating habits resulting to obesity and cardiovascular disorders among others.
Cost impact on health organization.
Increasing cost has impacted the national health organization/system in so many ways. The impacts are not only experienced by the patients but the providers, employers, payers (insurance bodies) and even other employees within the health organization. Firstly, an array of transformational changes has been made i.e. payment transformation where a shift has been made from volume-based (fee-for service payment) which has high cost implications to value-based models and also the development of primary care in attempt to counter increasing cost. The turnover of healthcare providers has also faced a fair share of cost impact. The providers burdened by the feeling of denying patients services due to inability to cater for cost or lack of insurance loses meaning of services and morale to continue with the service. Consequently, advancement in training and education improve the providers’ patient service and more enhanced application of Evidence-Based practice appears costly and unaffiliated hence promoting low morale. Morbidity and mortality cases has been on the rise. Advanced technology used in diagnosis/treatment of serious medical conditions has become expensive and some of them are not covered by the insurance (core payments) hence late interventions taken after serious damage. The is also an indication of lowered patient engagement as far healthcare decision making is concerned since patients with financial challenge have limited options and are sometimes forced to comply with the physici.
Running Head PERTINENT HEALTHCARE ISSUE1PERTINENT HEALTHCAR.docxglendar3
Running Head: PERTINENT HEALTHCARE ISSUE 1
PERTINENT HEALTHCARE ISSUE 2
Analysis of Pertinent Healthcare Issue
Students Name:
Institutional Affiliation:
Impact of increasing cost in a health organization
Introduction
The cost of receiving healthcare service is becoming a serious national healthcare concern. It has been established that the United States spend more on healthcare, in relation to the national income than any other industrialized nation. However, achieving minimum cost means having to make certain hard compromises which have never been easy. For example, low expenditure on research and development, limitation in terms of the choices of health coverage or healthcare providers and having to wait for long before using new technologies. The health system has gone through a series of transformational changes that has seen the cost of healthcare provision sky-rocket. The most affected are among the 41 million uninsured Americans who are unable to cater for the cost of insurance as well as the underinsured whose coverage program cannot cater for their overall health needs. The major catalyst behind the rising cost of healthcare has been; the rising number of aging population that take great benefit from the technologies created for lengthening life span, lifestyle choices like adoption of sedentary lifestyle and unhealthy eating habits resulting to obesity and cardiovascular disorders among others.
Cost impact on health organization.
Increasing cost has impacted the national health organization/system in so many ways. The impacts are not only experienced by the patients but the providers, employers, payers (insurance bodies) and even other employees within the health organization. Firstly, an array of transformational changes has been made i.e. payment transformation where a shift has been made from volume-based (fee-for service payment) which has high cost implications to value-based models and also the development of primary care in attempt to counter increasing cost. The turnover of healthcare providers has also faced a fair share of cost impact. The providers burdened by the feeling of denying patients services due to inability to cater for cost or lack of insurance loses meaning of services and morale to continue with the service. Consequently, advancement in training and education improve the providers’ patient service and more enhanced application of Evidence-Based practice appears costly and unaffiliated hence promoting low morale. Morbidity and mortality cases has been on the rise. Advanced technology used in diagnosis/treatment of serious medical conditions has become expensive and some of them are not covered by the insurance (core payments) hence late interventions taken after serious damage. The is also an indication of lowered patient engagement as far healthcare decision making is concerned since patients with financial challenge have limited options and are sometimes forced to comply with the physici.
What quality measures does the MCO have in placeSolutionManag.pdfformicreation
What quality measures does the MCO have in place?
Solution
Managed care organizations (MCOs) are responsible for ensuring that persons enrolled in their
plans receive quality health care. In addition, MCOs publicly funded through the Medicare and
Medicaid programs are required by State and Federal governments to meet certain quality
standards.
To fulfill their responsibilities, MCOs need ready access to a comprehensive array of evidence-
based clinical information and other clinical performance measures to enable them to evaluate
their providers\' performance and identify areas where improvement is needed. They also need to
know how their members feel about the care they receive and the way they are treated. Finally,
they need to ensure that both their providers and members are aware of the most recent
preventive care recommendations.
Valid, reliable, and cost-effective measurement tools must be available to make such
determinations, but these tools have not always been available. Furthermore, because the science
of performance measurement is relatively new, additional measures need to be developed and
those that have been developed can be improved. Therefore, to ensure that their enrollees in
MCOs receive high-quality care, MCOs need a reliable source to provide the most current and
scientifically sound tools.
In response to this need, the Agency for Healthcare Research and Quality (AHRQ) has funded
research to compile a database of evidence-based clinical guidelines and to develop clinical
performance measures, member satisfaction surveys, and preventive care recommendations that
can help MCOs meet their responsibilities. Additionally, AHRQ funds research and develops
performance measures and guidelines that MCOs, insurers, providers, and consumers can trust.
This report describes these tools and how they have been used and provides information on
where to learn more about them.
Background
Around one-half of insured Americans are enrolled in some form of managed care. However, as
the number of persons enrolled in MCOs increased in the 1990s, health care purchasers,
policymakers, and other stakeholders became concerned about the potential for health care
quality to diminish. In their view, the policies and practices imposed by MCOs to reduce what
MCOs define as unnecessary care might result in patients not receiving needed care. Therefore,
MCOs faced accreditation systems and other requirements to ensure that patients were receiving
the most appropriate care.
More recently, MCOs have had to address other emerging concerns such as: Rapid introduction
of new technologies, Data showing unexplained variations in the provision of care, Severe cost
pressures.
These factors have provided additional motivation to MCOs to develop systematic ways of
preserving and enhancing health care quality and cost-effectiveness.
Evidence-based practice guidelines and performance measures were developed to help ensure
that patients always receive the most appropri.
Read the scenario that you will use for the Individual Projects in ea.pdfashokarians
Read the scenario that you will use for the Individual Projects in each week of the course. The
Centers for Medicare and Medicaid Services (CMS) has taken on a more visible role in health
care delivery. Many changes have transpired to improve patient safety along with the
implementation of additional quality metrics, and these changes impact reimbursement rates
Likewise, the Patient Protection and Affordable Care Act has changed the reimbursement fee
structure of Medicare and Medicaid reimbursement for health care services. Other legislation
including the HITECH Act and the Medicare Authorization and CHIP Reactivation Act of 2015
(MACRA) all impact how healthcare organizations receive reimbursement and demonstrate use
of data to improve quality and delivery of patient care Mr. Magone, CEO of Healing Hands
Hospital, has asked you to join the \"Future of Healing Hands Task Force, and your first
assignment is to work with the Hospital Chief Financial Officer, Mr. Johnson, and provide a
summary of the current regulations regarding Medicare reimbursement including how MACR
impact reimbursement if/when Healing Hands coordinates delivery of services by affiliating with
physician practices For this assignment, write a 2-3 page report that you will deliver to Mr.
Magone on how the new CMS initiatives and regulations impact the organization\'s revenue
structure. In your presentation, address the following questions: Why did CMS become more
involved in the reimbursement component of health care? How does CMS\'s involvement impact
the reimbursement model for Healing Hands Hospital and other health care organizations If
CMS reimbursement regulations for Medicare and Medicaid change, does it follow that other
insurance providers change heir policies on reimbursement? What tools can be implemented to
ensure organizations such as Healing Hands Hospital and physician practices are meeting the
policies and procedures set forth by CMS? Identify 3 tools from the CMS Web site that are
helpful in meeting the requirements for Medicare reimbursement set forth by CMS
Solution
Part-a & part-b:
The physician’s work, practice expense, and malpractice, RVU values, CMS (centers for
Medicare and Medicaid services) is required to control overall expenditures in health care
organization. Therefore, CMS become highly involved in the reimbursement component of
health care to patients as per their \"insurance packages\". The CMS\' involvement in “budget
Neutrality” & the reimbursement model at Healing Hand hospital & other health care
organizations is mainly for physician RVU based payments from Medicare & Medicare that can
control its physician costs by adjusting physician payment rates based on “previous periods in a
calendar year” as per federal acts and regulations. The Medicare is going to control physicians
costs according to “medical procedures and medical visits of their record” in a Jan- 1 ending Dec
31. Conversion Factor is main basis to control the physician costs ac.
This report is written for the Board of Directors of the Nazarene Community Health Clinic (NCHC). It outlines the importance and necessity of quality management as it pertains to the health care reform’s mandate that all Americans have access to quality, affordable health care.
Background: A unique statewide multipayer initiative in Pennsylvania was undertaken to implement the Patient-Centered Medical Home (PCMH) with diabetes as an initial target disease. it is and one of the largest PCMH multipayer
initiatives.
Results: During the first intervention year (May
2008–May 2009), all practices achieved at least Level 1 National Committee for Quality Assurance (NCQA) Physician
Practice Connections Patient-Centered Medical Home
(PPC-PCMH) recognition. There was significant improvement in the percentage of patients who had evidence-based
complications screening and who were on therapies to reduce morbidity and mortality (statins, angiotensin-converting enzyme inhibitors). In addition, there were small but statistically significant improvements in key clinical parameters for blood pressure and cholesterol levels, with the greatest absolute improvement in the highest-risk patients.
Conclusions: Transforming primary care delivery through
implementation of the PCMH and CCM supported
by multipayer infrastructure
4508 Final Quality Project Part 2 Clinical Quality Measur.docxblondellchancy
4508 Final Quality Project
Part 2: Clinical Quality Measures for Hospitals
Overview
This activity focuses on Quality Measures for Hospitals. The activity uses online resources from
the CMS website. The Clinical Quality Measures for Hospitals activity focuses on the Hospital
Value Based Purchasing (VBP) Program
Background
The National Quality Strategy (NQS) was first published in March 2011 as the National Strategy
for Quality Improvement in Health Care, and is led by the Agency for Healthcare Research and
Quality on behalf of the U.S. Department of Health and Human Services (HHS). Today, the NQS
serves as a guide for identifying and prioritizing quality improvement efforts, sharing lessons
learned, and measuring the collective success of Federal, State, and public‐ and private‐sector
healthcare stakeholders across the country.
The Aims of the NQS are threefold:
Better Care: Improve the overall quality by making health care more patient‐centered,
reliable, accessible, and safe.
Healthy People/Healthy Communities: Improve the health of the U.S. population by
supporting proven interventions to address behavioral, social, and environmental
determinants of health in addition to delivering higher‐quality care.
Affordable Care: Reduce the cost of quality health care for individuals, families,
employers, and government.
To align with this, CMS has set goals for their Quality Strategy. These include:
• Make care safer by reducing harm caused in the delivery of care
– Improve support for a culture of safety
– Reduce inappropriate and unnecessary care
– Prevent or minimize harm in all settings
• Strengthen person and family engagement as partners in their care
• Promote effective communication and coordination of care
• Promote effective prevention and treatment of chronic disease
• Work with communities to promote best practices of healthy living
• Make care affordable
CMS’s vision states that if we can find better ways to pay providers, deliver care, and distribute
information than patients can receive better care, health dollars are spent more wisely, and
there are healthier communities, a healthier economy, and a healthier county. It is with this in
mind that they have created multiple quality payment programs.
In January 2015, the Department of Health and Human Services made an announcement that
set in place measurable goals and a timeline to move the Medicare program towards paying
providers based on the quality of care rather than the quantity. This was the first time in the
history of the program that explicit goals were set. They invited private sector payers to match
or exceed these goals as well. These goals included:
1. Alternative Payment Models
a. 30% of Medicare payments tied to quality or value through Alternative Payment
models by the end of 2016 and 50% by the end of 2018
2. Linking Fee‐For‐Service payments to Quality/Value
a. 85% of all Medi ...
4508 Final Quality Project Part 2 Clinical Quality Measurromeliadoan
4508 Final Quality Project
Part 2: Clinical Quality Measures for Hospitals
Overview
This activity focuses on Quality Measures for Hospitals. The activity uses online resources from
the CMS website. The Clinical Quality Measures for Hospitals activity focuses on the Hospital
Value Based Purchasing (VBP) Program
Background
The National Quality Strategy (NQS) was first published in March 2011 as the National Strategy
for Quality Improvement in Health Care, and is led by the Agency for Healthcare Research and
Quality on behalf of the U.S. Department of Health and Human Services (HHS). Today, the NQS
serves as a guide for identifying and prioritizing quality improvement efforts, sharing lessons
learned, and measuring the collective success of Federal, State, and public‐ and private‐sector
healthcare stakeholders across the country.
The Aims of the NQS are threefold:
Better Care: Improve the overall quality by making health care more patient‐centered,
reliable, accessible, and safe.
Healthy People/Healthy Communities: Improve the health of the U.S. population by
supporting proven interventions to address behavioral, social, and environmental
determinants of health in addition to delivering higher‐quality care.
Affordable Care: Reduce the cost of quality health care for individuals, families,
employers, and government.
To align with this, CMS has set goals for their Quality Strategy. These include:
• Make care safer by reducing harm caused in the delivery of care
– Improve support for a culture of safety
– Reduce inappropriate and unnecessary care
– Prevent or minimize harm in all settings
• Strengthen person and family engagement as partners in their care
• Promote effective communication and coordination of care
• Promote effective prevention and treatment of chronic disease
• Work with communities to promote best practices of healthy living
• Make care affordable
CMS’s vision states that if we can find better ways to pay providers, deliver care, and distribute
information than patients can receive better care, health dollars are spent more wisely, and
there are healthier communities, a healthier economy, and a healthier county. It is with this in
mind that they have created multiple quality payment programs.
In January 2015, the Department of Health and Human Services made an announcement that
set in place measurable goals and a timeline to move the Medicare program towards paying
providers based on the quality of care rather than the quantity. This was the first time in the
history of the program that explicit goals were set. They invited private sector payers to match
or exceed these goals as well. These goals included:
1. Alternative Payment Models
a. 30% of Medicare payments tied to quality or value through Alternative Payment
models by the end of 2016 and 50% by the end of 2018
2. Linking Fee‐For‐Service payments to Quality/Value
a. 85% of all Medi ...
Health Economics In Clinical Trials - Pubricapubrica101
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Resetting Payer-Provider Arrangements for COVID-19 and the Evolving Improveme...Health Catalyst
As the healthcare industry recovers from COVID-19, providers are re-evaluating the financial arrangements that motivate them to improve their processes while benefiting payers and patients.
With the pandemic driving lower provider volumes and straining hospital resources, the industry has a renewed urgency for policies that drive better outcomes while lowering cost and improving revenue. Moving forward, healthcare must reset its payer-provider performance standards to the post COVID-19 environment.
Renewed approaches to the following models will consider the impact of remote care, how to reimburse telehealth services, and the need for consistent payments to providers:
1. Pay for performance.
2. Bundled payments.
3. ACOs.
Current System Issues and Their ImpactsIntroductionBefore we .docxalanrgibson41217
Current System Issues and Their Impacts
Introduction
Before we can discuss change and innovation in our health care delivery system, a strong understanding of the current system is necessary, including how it functions, what types of incentives are at work, and how the different entities inside it work with and impact each other.
What Elements Drive Our Current System?
There are several key drivers of the existing system, and among these are the money, providers, payers, and consumers. When examining the behavior of any system, it is useful to look at the series of rewards and consequences that drive behavior. In health care, this means that much can be learned about the system's behavior by following the money trail. What things are reimbursed, under what circumstances, and with what outcomes? Under what circumstances are consequences, such as not getting paid, applied? In the current system, payments are highest for procedures, and proceduralists such as surgeons, gastroenterologists, and interventional cardiologists are all paid much higher fees than are family practice physicians, pediatricians, or hospitalists, all of whom manage medical care. Hospitals function under the same premise. Approximately 75% of the revenue for the average community hospital comes from surgeries, and another 12% comes from diagnostic imaging procedures. Additional amounts come from cardiac diagnostic and interventional procedures. So, approximately 90% to 95% of revenue comes from performing procedures on patients rather than providing management of diseases through medications or other noninvasive treatments. Thus, the system is focused on rewarding procedures that lead to "curing" and focused away from medical management of chronic diseases or prevention of disease and illness.
Financial Elements
Without doubt, money is one of, if not the, most powerful drivers of system functioning. For a classic example, we can look at the old fee-for-service payment methodology prevalent in the 1960s and 1970s, and contrast it with Medicare's implementation of diagnosis-related groups (DRGs) as a payment mechanism in 1983. Under fee-for-service health care, providers used whatever procedures, equipment, and supplies they felt were needed for care, and they submitted a bill that charged for each item. The payors received the bill, corrected any errors, and then issued a check for the corrected amount to the providers. If a provider wished to make a larger profit, they could provide more services or billable items to increase the payment. It comes as no great surprise to note that utilization of services and cost both rose rapidly under this methodology, since there was no incentive to be frugal. When Medicare changed its reimbursement to DRGs, the system began to experience the impact of being paid one flat fee, set by DRG, for the entire admission, regardless of how much care was rendered. For example, if a hospital provided care at a cost below the DRG payment, it was ab.
1. Analyze the case and determine the factors that have made KFC a s.docxaulasnilda
1. Analyze the case and determine the factors that have made KFC a successful global business.
2. Why are cultural factors so important to KFC’s sales success in India and China?
3. Spot the cultural factors in India that go against KFC’s original recipe.
4. Why did Kentucky Fried Chicken change its name to KFC?
5. What PESTEL factors contributed to KFC’s positioning?
6. How does the SWOT analysis of KFC affect the future of KFC?
Points to be considered:
1. Please follow 6th edition of the APA Format.
2. On separate page, the word "Abstract,' centered on paper followed by 75-100 word overview.
3. References needs to be Peer Reviewed Articles.
4. This assignment should be 15-20 pages excluding the title and reference pages. The paper should contain at least one graph, figure, chart, or table.
5. Please use the questions as Headings for the topics in the Paper.
I have attached the case study document below.
.
1. A.Discuss how the concept of health has changed over time. B.Di.docxaulasnilda
1. A.Discuss how the concept of "health" has changed over time. B.Discuss how the concept has evolved to include wellness, illness, and overall well-being. C.How has health promotion changed over time? D.Why is it important that nurses implement health promotion interventions based on evidence-based practice?
2. A.Compare and contrast the three different levels of health promotion (primary, secondary, tertiary). B.Discuss how the levels of prevention help determine educational needs for a patient.
.
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Running Head PERTINENT HEALTHCARE ISSUE1PERTINENT HEALTHCAR.docxglendar3
Running Head: PERTINENT HEALTHCARE ISSUE 1
PERTINENT HEALTHCARE ISSUE 2
Analysis of Pertinent Healthcare Issue
Students Name:
Institutional Affiliation:
Impact of increasing cost in a health organization
Introduction
The cost of receiving healthcare service is becoming a serious national healthcare concern. It has been established that the United States spend more on healthcare, in relation to the national income than any other industrialized nation. However, achieving minimum cost means having to make certain hard compromises which have never been easy. For example, low expenditure on research and development, limitation in terms of the choices of health coverage or healthcare providers and having to wait for long before using new technologies. The health system has gone through a series of transformational changes that has seen the cost of healthcare provision sky-rocket. The most affected are among the 41 million uninsured Americans who are unable to cater for the cost of insurance as well as the underinsured whose coverage program cannot cater for their overall health needs. The major catalyst behind the rising cost of healthcare has been; the rising number of aging population that take great benefit from the technologies created for lengthening life span, lifestyle choices like adoption of sedentary lifestyle and unhealthy eating habits resulting to obesity and cardiovascular disorders among others.
Cost impact on health organization.
Increasing cost has impacted the national health organization/system in so many ways. The impacts are not only experienced by the patients but the providers, employers, payers (insurance bodies) and even other employees within the health organization. Firstly, an array of transformational changes has been made i.e. payment transformation where a shift has been made from volume-based (fee-for service payment) which has high cost implications to value-based models and also the development of primary care in attempt to counter increasing cost. The turnover of healthcare providers has also faced a fair share of cost impact. The providers burdened by the feeling of denying patients services due to inability to cater for cost or lack of insurance loses meaning of services and morale to continue with the service. Consequently, advancement in training and education improve the providers’ patient service and more enhanced application of Evidence-Based practice appears costly and unaffiliated hence promoting low morale. Morbidity and mortality cases has been on the rise. Advanced technology used in diagnosis/treatment of serious medical conditions has become expensive and some of them are not covered by the insurance (core payments) hence late interventions taken after serious damage. The is also an indication of lowered patient engagement as far healthcare decision making is concerned since patients with financial challenge have limited options and are sometimes forced to comply with the physici.
What quality measures does the MCO have in placeSolutionManag.pdfformicreation
What quality measures does the MCO have in place?
Solution
Managed care organizations (MCOs) are responsible for ensuring that persons enrolled in their
plans receive quality health care. In addition, MCOs publicly funded through the Medicare and
Medicaid programs are required by State and Federal governments to meet certain quality
standards.
To fulfill their responsibilities, MCOs need ready access to a comprehensive array of evidence-
based clinical information and other clinical performance measures to enable them to evaluate
their providers\' performance and identify areas where improvement is needed. They also need to
know how their members feel about the care they receive and the way they are treated. Finally,
they need to ensure that both their providers and members are aware of the most recent
preventive care recommendations.
Valid, reliable, and cost-effective measurement tools must be available to make such
determinations, but these tools have not always been available. Furthermore, because the science
of performance measurement is relatively new, additional measures need to be developed and
those that have been developed can be improved. Therefore, to ensure that their enrollees in
MCOs receive high-quality care, MCOs need a reliable source to provide the most current and
scientifically sound tools.
In response to this need, the Agency for Healthcare Research and Quality (AHRQ) has funded
research to compile a database of evidence-based clinical guidelines and to develop clinical
performance measures, member satisfaction surveys, and preventive care recommendations that
can help MCOs meet their responsibilities. Additionally, AHRQ funds research and develops
performance measures and guidelines that MCOs, insurers, providers, and consumers can trust.
This report describes these tools and how they have been used and provides information on
where to learn more about them.
Background
Around one-half of insured Americans are enrolled in some form of managed care. However, as
the number of persons enrolled in MCOs increased in the 1990s, health care purchasers,
policymakers, and other stakeholders became concerned about the potential for health care
quality to diminish. In their view, the policies and practices imposed by MCOs to reduce what
MCOs define as unnecessary care might result in patients not receiving needed care. Therefore,
MCOs faced accreditation systems and other requirements to ensure that patients were receiving
the most appropriate care.
More recently, MCOs have had to address other emerging concerns such as: Rapid introduction
of new technologies, Data showing unexplained variations in the provision of care, Severe cost
pressures.
These factors have provided additional motivation to MCOs to develop systematic ways of
preserving and enhancing health care quality and cost-effectiveness.
Evidence-based practice guidelines and performance measures were developed to help ensure
that patients always receive the most appropri.
Read the scenario that you will use for the Individual Projects in ea.pdfashokarians
Read the scenario that you will use for the Individual Projects in each week of the course. The
Centers for Medicare and Medicaid Services (CMS) has taken on a more visible role in health
care delivery. Many changes have transpired to improve patient safety along with the
implementation of additional quality metrics, and these changes impact reimbursement rates
Likewise, the Patient Protection and Affordable Care Act has changed the reimbursement fee
structure of Medicare and Medicaid reimbursement for health care services. Other legislation
including the HITECH Act and the Medicare Authorization and CHIP Reactivation Act of 2015
(MACRA) all impact how healthcare organizations receive reimbursement and demonstrate use
of data to improve quality and delivery of patient care Mr. Magone, CEO of Healing Hands
Hospital, has asked you to join the \"Future of Healing Hands Task Force, and your first
assignment is to work with the Hospital Chief Financial Officer, Mr. Johnson, and provide a
summary of the current regulations regarding Medicare reimbursement including how MACR
impact reimbursement if/when Healing Hands coordinates delivery of services by affiliating with
physician practices For this assignment, write a 2-3 page report that you will deliver to Mr.
Magone on how the new CMS initiatives and regulations impact the organization\'s revenue
structure. In your presentation, address the following questions: Why did CMS become more
involved in the reimbursement component of health care? How does CMS\'s involvement impact
the reimbursement model for Healing Hands Hospital and other health care organizations If
CMS reimbursement regulations for Medicare and Medicaid change, does it follow that other
insurance providers change heir policies on reimbursement? What tools can be implemented to
ensure organizations such as Healing Hands Hospital and physician practices are meeting the
policies and procedures set forth by CMS? Identify 3 tools from the CMS Web site that are
helpful in meeting the requirements for Medicare reimbursement set forth by CMS
Solution
Part-a & part-b:
The physician’s work, practice expense, and malpractice, RVU values, CMS (centers for
Medicare and Medicaid services) is required to control overall expenditures in health care
organization. Therefore, CMS become highly involved in the reimbursement component of
health care to patients as per their \"insurance packages\". The CMS\' involvement in “budget
Neutrality” & the reimbursement model at Healing Hand hospital & other health care
organizations is mainly for physician RVU based payments from Medicare & Medicare that can
control its physician costs by adjusting physician payment rates based on “previous periods in a
calendar year” as per federal acts and regulations. The Medicare is going to control physicians
costs according to “medical procedures and medical visits of their record” in a Jan- 1 ending Dec
31. Conversion Factor is main basis to control the physician costs ac.
This report is written for the Board of Directors of the Nazarene Community Health Clinic (NCHC). It outlines the importance and necessity of quality management as it pertains to the health care reform’s mandate that all Americans have access to quality, affordable health care.
Background: A unique statewide multipayer initiative in Pennsylvania was undertaken to implement the Patient-Centered Medical Home (PCMH) with diabetes as an initial target disease. it is and one of the largest PCMH multipayer
initiatives.
Results: During the first intervention year (May
2008–May 2009), all practices achieved at least Level 1 National Committee for Quality Assurance (NCQA) Physician
Practice Connections Patient-Centered Medical Home
(PPC-PCMH) recognition. There was significant improvement in the percentage of patients who had evidence-based
complications screening and who were on therapies to reduce morbidity and mortality (statins, angiotensin-converting enzyme inhibitors). In addition, there were small but statistically significant improvements in key clinical parameters for blood pressure and cholesterol levels, with the greatest absolute improvement in the highest-risk patients.
Conclusions: Transforming primary care delivery through
implementation of the PCMH and CCM supported
by multipayer infrastructure
4508 Final Quality Project Part 2 Clinical Quality Measur.docxblondellchancy
4508 Final Quality Project
Part 2: Clinical Quality Measures for Hospitals
Overview
This activity focuses on Quality Measures for Hospitals. The activity uses online resources from
the CMS website. The Clinical Quality Measures for Hospitals activity focuses on the Hospital
Value Based Purchasing (VBP) Program
Background
The National Quality Strategy (NQS) was first published in March 2011 as the National Strategy
for Quality Improvement in Health Care, and is led by the Agency for Healthcare Research and
Quality on behalf of the U.S. Department of Health and Human Services (HHS). Today, the NQS
serves as a guide for identifying and prioritizing quality improvement efforts, sharing lessons
learned, and measuring the collective success of Federal, State, and public‐ and private‐sector
healthcare stakeholders across the country.
The Aims of the NQS are threefold:
Better Care: Improve the overall quality by making health care more patient‐centered,
reliable, accessible, and safe.
Healthy People/Healthy Communities: Improve the health of the U.S. population by
supporting proven interventions to address behavioral, social, and environmental
determinants of health in addition to delivering higher‐quality care.
Affordable Care: Reduce the cost of quality health care for individuals, families,
employers, and government.
To align with this, CMS has set goals for their Quality Strategy. These include:
• Make care safer by reducing harm caused in the delivery of care
– Improve support for a culture of safety
– Reduce inappropriate and unnecessary care
– Prevent or minimize harm in all settings
• Strengthen person and family engagement as partners in their care
• Promote effective communication and coordination of care
• Promote effective prevention and treatment of chronic disease
• Work with communities to promote best practices of healthy living
• Make care affordable
CMS’s vision states that if we can find better ways to pay providers, deliver care, and distribute
information than patients can receive better care, health dollars are spent more wisely, and
there are healthier communities, a healthier economy, and a healthier county. It is with this in
mind that they have created multiple quality payment programs.
In January 2015, the Department of Health and Human Services made an announcement that
set in place measurable goals and a timeline to move the Medicare program towards paying
providers based on the quality of care rather than the quantity. This was the first time in the
history of the program that explicit goals were set. They invited private sector payers to match
or exceed these goals as well. These goals included:
1. Alternative Payment Models
a. 30% of Medicare payments tied to quality or value through Alternative Payment
models by the end of 2016 and 50% by the end of 2018
2. Linking Fee‐For‐Service payments to Quality/Value
a. 85% of all Medi ...
4508 Final Quality Project Part 2 Clinical Quality Measurromeliadoan
4508 Final Quality Project
Part 2: Clinical Quality Measures for Hospitals
Overview
This activity focuses on Quality Measures for Hospitals. The activity uses online resources from
the CMS website. The Clinical Quality Measures for Hospitals activity focuses on the Hospital
Value Based Purchasing (VBP) Program
Background
The National Quality Strategy (NQS) was first published in March 2011 as the National Strategy
for Quality Improvement in Health Care, and is led by the Agency for Healthcare Research and
Quality on behalf of the U.S. Department of Health and Human Services (HHS). Today, the NQS
serves as a guide for identifying and prioritizing quality improvement efforts, sharing lessons
learned, and measuring the collective success of Federal, State, and public‐ and private‐sector
healthcare stakeholders across the country.
The Aims of the NQS are threefold:
Better Care: Improve the overall quality by making health care more patient‐centered,
reliable, accessible, and safe.
Healthy People/Healthy Communities: Improve the health of the U.S. population by
supporting proven interventions to address behavioral, social, and environmental
determinants of health in addition to delivering higher‐quality care.
Affordable Care: Reduce the cost of quality health care for individuals, families,
employers, and government.
To align with this, CMS has set goals for their Quality Strategy. These include:
• Make care safer by reducing harm caused in the delivery of care
– Improve support for a culture of safety
– Reduce inappropriate and unnecessary care
– Prevent or minimize harm in all settings
• Strengthen person and family engagement as partners in their care
• Promote effective communication and coordination of care
• Promote effective prevention and treatment of chronic disease
• Work with communities to promote best practices of healthy living
• Make care affordable
CMS’s vision states that if we can find better ways to pay providers, deliver care, and distribute
information than patients can receive better care, health dollars are spent more wisely, and
there are healthier communities, a healthier economy, and a healthier county. It is with this in
mind that they have created multiple quality payment programs.
In January 2015, the Department of Health and Human Services made an announcement that
set in place measurable goals and a timeline to move the Medicare program towards paying
providers based on the quality of care rather than the quantity. This was the first time in the
history of the program that explicit goals were set. They invited private sector payers to match
or exceed these goals as well. These goals included:
1. Alternative Payment Models
a. 30% of Medicare payments tied to quality or value through Alternative Payment
models by the end of 2016 and 50% by the end of 2018
2. Linking Fee‐For‐Service payments to Quality/Value
a. 85% of all Medi ...
Health Economics In Clinical Trials - Pubricapubrica101
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Resetting Payer-Provider Arrangements for COVID-19 and the Evolving Improveme...Health Catalyst
As the healthcare industry recovers from COVID-19, providers are re-evaluating the financial arrangements that motivate them to improve their processes while benefiting payers and patients.
With the pandemic driving lower provider volumes and straining hospital resources, the industry has a renewed urgency for policies that drive better outcomes while lowering cost and improving revenue. Moving forward, healthcare must reset its payer-provider performance standards to the post COVID-19 environment.
Renewed approaches to the following models will consider the impact of remote care, how to reimburse telehealth services, and the need for consistent payments to providers:
1. Pay for performance.
2. Bundled payments.
3. ACOs.
Current System Issues and Their ImpactsIntroductionBefore we .docxalanrgibson41217
Current System Issues and Their Impacts
Introduction
Before we can discuss change and innovation in our health care delivery system, a strong understanding of the current system is necessary, including how it functions, what types of incentives are at work, and how the different entities inside it work with and impact each other.
What Elements Drive Our Current System?
There are several key drivers of the existing system, and among these are the money, providers, payers, and consumers. When examining the behavior of any system, it is useful to look at the series of rewards and consequences that drive behavior. In health care, this means that much can be learned about the system's behavior by following the money trail. What things are reimbursed, under what circumstances, and with what outcomes? Under what circumstances are consequences, such as not getting paid, applied? In the current system, payments are highest for procedures, and proceduralists such as surgeons, gastroenterologists, and interventional cardiologists are all paid much higher fees than are family practice physicians, pediatricians, or hospitalists, all of whom manage medical care. Hospitals function under the same premise. Approximately 75% of the revenue for the average community hospital comes from surgeries, and another 12% comes from diagnostic imaging procedures. Additional amounts come from cardiac diagnostic and interventional procedures. So, approximately 90% to 95% of revenue comes from performing procedures on patients rather than providing management of diseases through medications or other noninvasive treatments. Thus, the system is focused on rewarding procedures that lead to "curing" and focused away from medical management of chronic diseases or prevention of disease and illness.
Financial Elements
Without doubt, money is one of, if not the, most powerful drivers of system functioning. For a classic example, we can look at the old fee-for-service payment methodology prevalent in the 1960s and 1970s, and contrast it with Medicare's implementation of diagnosis-related groups (DRGs) as a payment mechanism in 1983. Under fee-for-service health care, providers used whatever procedures, equipment, and supplies they felt were needed for care, and they submitted a bill that charged for each item. The payors received the bill, corrected any errors, and then issued a check for the corrected amount to the providers. If a provider wished to make a larger profit, they could provide more services or billable items to increase the payment. It comes as no great surprise to note that utilization of services and cost both rose rapidly under this methodology, since there was no incentive to be frugal. When Medicare changed its reimbursement to DRGs, the system began to experience the impact of being paid one flat fee, set by DRG, for the entire admission, regardless of how much care was rendered. For example, if a hospital provided care at a cost below the DRG payment, it was ab.
1. Analyze the case and determine the factors that have made KFC a s.docxaulasnilda
1. Analyze the case and determine the factors that have made KFC a successful global business.
2. Why are cultural factors so important to KFC’s sales success in India and China?
3. Spot the cultural factors in India that go against KFC’s original recipe.
4. Why did Kentucky Fried Chicken change its name to KFC?
5. What PESTEL factors contributed to KFC’s positioning?
6. How does the SWOT analysis of KFC affect the future of KFC?
Points to be considered:
1. Please follow 6th edition of the APA Format.
2. On separate page, the word "Abstract,' centered on paper followed by 75-100 word overview.
3. References needs to be Peer Reviewed Articles.
4. This assignment should be 15-20 pages excluding the title and reference pages. The paper should contain at least one graph, figure, chart, or table.
5. Please use the questions as Headings for the topics in the Paper.
I have attached the case study document below.
.
1. A.Discuss how the concept of health has changed over time. B.Di.docxaulasnilda
1. A.Discuss how the concept of "health" has changed over time. B.Discuss how the concept has evolved to include wellness, illness, and overall well-being. C.How has health promotion changed over time? D.Why is it important that nurses implement health promotion interventions based on evidence-based practice?
2. A.Compare and contrast the three different levels of health promotion (primary, secondary, tertiary). B.Discuss how the levels of prevention help determine educational needs for a patient.
.
1. Abstract2. Introduction to Bitcoin and Ethereum3..docxaulasnilda
1.
Abstract
2.
Introduction to Bitcoin and Ethereum
3.
Background
a. How do we understand Ethereum and Smart Contracts?
b. Blockchain Cryptocurrency and Smart Contracts
c. What are Pros and Cons of using Ethereum?
d. Ethereum Virtual Machine
4.
Platforms or Programming for Smart Contracts
5.
Smart Contract Applications
6.
Research Methodology
a. Current Smart Contract Applications
b. Security Issues
c. Privacy Issues
d. Performance Issues
7.
Ethereum System and Solidity Smart Contracts
a. What do we understand about Ethereum and the Likes?
b. How does Ethereum and the likes work?
8.
Ethereum and Hyperledger in Smart Contracts
9.
What can we get by the term Scalability?
10.
Smart Contracting Programming and High-Level Issues
a. Usability
b. Ethical and Legal Issues
11.
Specifications and Implementations
12.
Pros and Cons of using Ethereum Smart Contracts
13.
Current Trends on Ethereum
14.
Future State of Ethereum Smart Contracts or Virtual Machines
15.
Conclusion
Note: Paper about Ethereum
20 pages
ppt 12-14 slides.
No plagiarism,
APA , Citations, and references.
.
1. A. Compare vulnerable populations. B. Describe an example of one .docxaulasnilda
1. A. Compare vulnerable populations. B. Describe an example of one of these groups in the United States or from another country. C.Explain why the population is designated as "vulnerable." Include the number of individuals belonging to this group and the specific challenges or issues involved. D. Discuss why these populations are unable to advocate for themselves, the ethical issues that must be considered when working with these groups, and how nursing advocacy would be beneficial.
2. A. How does the community health nurse recognize bias, stereotypes, and implicit bias within the community? B. How should the nurse address these concepts to ensure health promotion activities are culturally competent? C. Propose strategies that you can employ to reduce cultural dissonance and bias to deliver culturally competent care. D. Include an evidence-based article that addresses the cultural issue. E. Cite and reference the article in APA format.
.
1. A highly capable brick and mortar electronics retailer with a l.docxaulasnilda
1. A highly capable brick and mortar electronics retailer with a loyal regional customer base (such as Fry's) should adopt which of the following medium term strategies?
"50% off" sale every month
Divest
Niche or harvest
Invest in R&D
2. Amazon's strategy involves offering expanded variety but at very competitive prices. This is primarily achieved through
Economies of scope
Focus on international markets
Economies of scale
Innovative products
3. Uber is an example of industry chaining in which of the following ways?
Economies of scale for service providers
Economies of scope for customers
Improving access and reduced search costs for customers and service providers
Lower wages for service providers and lower prices for customers
4. Shareholder returns are primarily derived from
Growth in share value and dividend payments
dividend payments only
Growth in company profits
Growth in the share value only
5. Strategy is defined best as:
A unique value proposition supported by sound financial decisions
A unique value proposition supported by synergies in operations
A unique value proposition supported by aggressive marketing
A unique value proposition supported by a complex supply chain
6. The cost of attracting new customers is the highest with which of the following groups?
Early adopters
Late majority
Laggards
Innovators
7. In the context of the Differentiation (Quality) vs Efficiency trade-off curve, the efficient frontier refers to:
The company that provides maximum quality for a given cost
The company that provides minimum cost
The company that provides maximum quality
The company that maximizes efficiency
8. Nike hiring sports stars to be brand ambassadors is an example of which of the following mechanisms?
Market development
Customer segmentation
Product development
Market penetration
9. Which of the following is an indication of strategic committment of a company in an industry
Lowering wages of the workforce
Increased technology investment
Acquiring real-estate in an urban location of demand
Increased divident payments for two years in a row
10. A pharma company with a deep roster of capable engineers and scientists and that is the market leader is best advised to begin development of a new drug as:
A partnership with smaller competitors
License its innovation from other laboratories
An independent venture
Smaller scale effort
11. The most valuable competency in the declining phase of an industry is:
Resposiveness
Innovation
Efficiency
Quality
12. There is often limited capacity relative to demand in the early growth period of an industry because:
Capacity is very expensive in the later stages of an industry
Only few companies have products or technologies in a budding industry
Prices tend to be low in the embryonic stage
Many companies compete for early advantage in an emerging industry
13. If the willingness to pay of .
1. A. Research the delivery, finance, management, and sustainabili.docxaulasnilda
1. A. Research the delivery, finance, management, and sustainability methods of the U.S. health care system.
B. Evaluate the effectiveness of one or more of these areas on quality patient care and health outcomes.
C.Propose a potential health care reform solution to improve effectiveness in the area you evaluated and predict the expected effect.
D. Describe the effect of health care reform on the U.S. health care system and its respective stakeholders.
E.Support your post with a peer-reviewed journal article.
2. The Affordable Care Act was signed into law by President Barack Obama in March 2010. Many of the provisions of the law directly affect health care providers. Review the following topic materials:
"About the Affordable Care Act"
"Health Care Transformation: The Affordable Care Act and More"
What are the most important elements of the Affordable Care Act in relation to community and public health? What is the role of the nurse in implementing this law?
.
1. All of the following artists except for ONE used nudity as part.docxaulasnilda
1. All of the following artists except for ONE used nudity as part of her/ his work:
a) Ana Mendieta
b) Carolee Schneeman
c) Yoko Ono
d) Judy Chicago
e) Robert Mapplethorpe
2. All of the following except ONE are features of Conceptualism (though not all apply to every Conceptualist work)
a) Audience participation
b) Use of text/language within visual works
c) Direct criticism of the art museum
d) Very expensive artworks
e) Sets of instructions to follow
f) Temporary or fleeting projects
3. Please match the following description with correct art movement or tendency:
1) Minimalism
2) Fluxus
3) Abstract Expressionism
4) Feminist practices
5) Conceptualism
A. Created action paintings that blurred the line between art and life
B. Included works drawing attention to the unethical actions of art museums
C. An idealistic to recalibrate the human senses
D. A loose knit international group of artists that made performances and other unconventional works
E. Argued that the criteria for determining historical value in visual art has been too narrow
4. The following art movement or tendencies except for ONE can be considered to have been responses to Abstract Expressionism (through sometimes for very different reasons)
a) Conceptualism
b) Pop Art
c) Earthwork
d) Surrealism
e) Minimalism
.
1. According to the article, what is myth and how does it functi.docxaulasnilda
1. According to the article, what is myth and how does it function as a naturalizing agent?
2. What is a sign?What is its relation to myth?
3. If advertising “is not an attempted sale of products – evidence shows that consumers are able to resist ‘advertising in the imperative’(12.) – but a ‘clear expression of a culture’ and cultural beliefs” then what does the iPod advert express about current culture?
4. What does the iPod advert presented in the article “sell”?
Attachments have resources
.
1. 6 Paragraph OverviewReflection on Reading Assigbnment Due Before.docxaulasnilda
1. 6 Paragraph Overview/Reflection on Reading Assigbnment Due Before Class Commences
The Critical Theorists: Critical Legal Theory, Critical Race Theory, Critical Feminist Theory, & Critical Latinx Theory
Wacks Chapters 13 & 14
Bix Chapter 19
2.6 Paragraph Overview/Reflection on Reading Assigbnment Due Before Class Commences
Why Obey the Law & Why Punish?
Wacks Chapters 11 & 12
Bix Chapters 9 & 16
3.6 Paragraph Overview/Reflection on Reading Assigbnment Due Before Class Commences
Wacks Chapter 10
Bix Chapter 10
.
1. A.Compare independent variables, B.dependent variables, and C.ext.docxaulasnilda
1. A.Compare independent variables, B.dependent variables, and C.extraneous variables. D.Describe two ways that researchers attempt to control extraneous variables. E.Support your answer with peer-reviewed articles.
2. A.Describe the "levels of evidence" B. and provide an example of the type of practice change that could result from each.
.
1. According to the Court, why is death a proportionate penalty for .docxaulasnilda
1. According to the Court, why is death a proportionate penalty for child rape? Do you agree? Explain your reasons.
2. Who should make the decision as to what is the appropriate penalty for crimes? Courts? Legislatures? Juries? Defend your answer.
3. In deciding whether the death penalty for child rape is cruel and unusual, is it relevant that Louisiana is the only state that punishes child rape with death?
4. According to the Court, some crimes are worse than death. Do you agree? Is child rape one of them? Why? Why not?
THE RESPONSE TO THE FOUR QUESTIONS ALL TOGETHER SHOULD LEAD ADD UP TO 400 WORDS IN TOTAL.
.
1- Prisonization What if . . . you were sentenced to prison .docxaulasnilda
1- Prisonization?
What if . . . you were sentenced to prison? Do you believe you would become a more seasoned criminal or would learning criminal ways from those who were caught make you a worse criminal? Explain
2- Gangs of Prison?
What if . . . you were appointed as warden at a medium security prison which had a terrible problem with gang affiliations? What methods would you employ to combat the problem? Explain.
3-The solidarity of inmate culture (Big House era) developed through several characteristics. Name them?
.
1. 250+ word count What is cultural and linguistic competence H.docxaulasnilda
1. 250+ word count
What is cultural and linguistic competence? How does this competency apply to public health? Why is this important to the practice of public health?
2. 250+ word count
Reflect on your own cultural and linguistic competence. How confident are you in your ability to address the needs of diverse communities? How do you think you could improve your level of cultural and linguistic competence?
.
1. 200 words How valuable is a having a LinkedIn profile Provid.docxaulasnilda
1. 200 words How valuable is a having a LinkedIn profile? Provide example to support your statement.
2. 200 words What benefits does it add your academic and professional development? Provide example to support your statement.
3. 200 words How does having this profile contribute to networking as healthcare and public health professionals? Provide example to support your statement.
4. 200 words What other social media and networking platforms are available to network with other healthcare and public health professionals? Provide example to support your statement.
.
1. According to recent surveys, China, India, and the Philippines ar.docxaulasnilda
1. According to recent surveys, China, India, and the Philippines are the three most popular countries for IT outsourcing. Write a short paper (2-4 paragraphs) explaining what the appeal would be for US companies to outsource IT functions to these countries. You may discuss cost, labor pool, language, or possibly government support as your reasons. There are many other reasons you may choose to highlight in your paper. Be sure to use your own words.
2.) Many believe that cloud computing can reduce the total cost of computing and enhance “green computing” (environmental friendly). Why do you believe this to be correct? If you disagree, please explain why?
.
1. Addressing inflation using Fiscal and Monetary Policy tools.S.docxaulasnilda
1. Addressing inflation using Fiscal and Monetary Policy tools.
Scenario - The US economy is currently experiencing high rates of inflation. You
have Fiscal and Monetary policy tools available to address this problem:
a. To attack the problem of inflation you must select one Monetary Policy
tool and one Fiscal Policy tool. Write down the name of your Fiscal Policy
tool and your Monetary Policy tool.
i. Think the options through and write down your choices.
b. Please explain why you selected the tools that you selected and why you did
not select the other choices? Do this for both monetary and fiscal policy
tools!
i. Specifically, explain what is so good about the tool you selected and what is not so
good about the tools you did not select? Do this for both the Monetary Policy tool
and the Fiscal Policy tool. The key here is to use some decision criteria in making
your choice.
c. Thoroughly and completely explain how your solution (both the monetary
and the fiscal policy tool) would work to solve the problem of inflation, and
indicate the impact your solution would have on at least 5 key economic
variables. Be specific.
i. Present this using the chain of events format with up or down arrows to indicate the
direction of impact on each variable. I need to see the detail.
2. Addressing recession using Fiscal and Monetary Policy tools.
Scenario - The US economy is currently experiencing recession. You have Fiscal
and Monetary policy tools available to address this problem:
a. To attack the problem of recession, you must select at least one Monetary
Policy tool and one Fiscal Policy tool. Write down the name of your Fiscal
Policy tool and your Monetary Policy tool.
i. Think the options through and write down your choices.
b. Please explain why you selected the tools that you selected and why you did
not select the other choices? Do this for both monetary and fiscal policy
tools!
i. Specifically, explain what is so good about the tool you selected and what is not so
good about the tools you did not select? Do this for both the Monetary Policy tool
and the Fiscal Policy tool. The key here is to use some decision criteria in making
your choice.
c. Thoroughly and completely explain how your solution (both monetary and
fiscal policy tools) would work to solve the problem of recession, and
indicate the impact your solution would have on the key economic
variables. Be specific.
i. Present this using the chain of events format with up or down arrows to indicate the
direction of impact on each variable. I need to see the detail.
3. Please list and explain the 4 key supply side growth factors we discussed, and
discuss the viability (do-ability) of each in terms of getting our economy growing
again, given that today our economy is not growing.
a. The slides should provide you with what you need here.
b. The issue of viability – if the economy is growing slowly or not at all, do we have any chance
of achieving suc.
1. A vulnerability refers to a known weakness of an asset (resou.docxaulasnilda
1. A vulnerability refers to a
known
weakness of an asset (resource) that can be exploited by one or more attackers. In other words, it is a known issue that allows an attack to succeed.
For example, when a team member resigns and you forget to disable their access to external accounts, change logins, or remove their names from company credit cards, this leaves your business open to both intentional and unintentional threats. However, most vulnerabilities are exploited by automated attackers and not a human typing on the other side of the network.
Testing for vulnerabilities is critical to ensuring the continued security of your systems. Identify the weak points. Discuss at least four questions to ask when determining your security vulnerabilities.
2.
Topic:
Assume that you have been hired by a small veterinary practice to help them prepare a contingency planning document. The practice has a small LAN with four computers and Internet access. Prepare a list of threat categories and the associated business impact for each. Identify preventive measures for each type of threat category. Include at least one major disaster in the plan. 200-300 words.
.
1. According to the readings, philosophy began in ancient Egypt an.docxaulasnilda
1. According to the readings, philosophy began in ancient Egypt and then spread to Greece.
True/False
2. This question is based on the presentation of logical concepts in the first reading.
Consider the following argument: "All chemists are Lutheran. Rita is Lutheran. So, Rita must be a chemist."
Is the argument …
Deductive & Invalid
Inductive & Valid
Deductive & Strong
Inductive & Weak
3. Would Socrates agree or disagree with the following statement:
Each of us invents his or her own truth and if you feel it in your heart and really want it to be true then don't listen to those who criticize your belief.
He would agree
He would disagree
4. According to the first reading, Thales asked some important "gateway" questions. Which of the following is not one of the gateway questions discussed in the reading:
Does the diverse range of things we experience have a single common explanation or cause?
Does God exist?
Is the universe intelligible?
5. Scientism is the belief that science is one of many paths to truth about the world.
True/False
6. Deductive arguments always aim to show
The conclusion is probably true
The conclusion must be true
7. In the type of argument known as _____, we begin with premises about a phenomenon or state of affairs to be explained; then we reason from those premises to an explanation for that state of affairs.
deduction
inference to the best explanation
syllogism
anaological induction
8. In the online lecture, the multiverse hypothesis is put forward by Stenger in support of theism.
True/False
9. According to the reading, the cosmic coincidences were known in ancient times.
True/False
10. According to the reading, the problem with Darwin's claim that his theory of natural selection explains all the order in nature is that no evolutionary process of natural selection is possible unless a background system of amazing complexity already exists; but since it must exist prior to any evolutionary process, it cannot be explained as the result of an evolutionary process.
True/False
11. Suppose we have two highly improbable hypotheses: H1 and H2. Suppose H2 is slightly less improbable than H1, all else equal.
According to the presentation of best explanation arguments in the reading, H2 presents a more reasonable explanation than H1.
True/False
12. According to the reading, the fine tuning argument shows that we can know with certainty that an intelligent designer exists.
True/False
13. According to the readings, science cannot possibly explain the source of the order in the universe.
True/False
14. The design argument is presented in the readings as an analogical argument and it is also presented as an inference to the best explanation.
True/False
15. According to the online readings, Ockham's Razor favors the multiverse theory over theism,
True/False
16. The proposition that Mount Rainier has snow on its peak would be an example of a proposition known to be true a priori.
True/False
17. Which of the foll.
1-Explain what you understood from the paper with (one paragraph).docxaulasnilda
1-Explain what you understood from the paper with (one paragraph)
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3-What is the method used in the paper and what can you say about the data used and the empirical aspect of the paper.
4-What other common measurements out there for measuring income inequality, poverty, and development gap.
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1-Explanation of how healthcare policy can impact the advanced p.docxaulasnilda
1-Explanation of how healthcare policy can impact the advanced practice nurse profession
2-Explanation of why advocacy is considered an essential component of the advance practice nurse's role
3- Discuss the four pillars of Transformational leadership and the effect it may have on influencing policy change
Description
Explanation of how healthcare policy can impact the advanced practice nurse profession
Research healthcare policy for APNs on a state and national level and the impact on the APN profession
Explanation of why advocacy is considered an essential component of the advance practice nurse's role
Describe advocacy in healthcare terminology.
Discuss how advocacy is an essential role of the APN and the impact on patient care.
Discuss the four pillars of Transformational leadership and the effect it may have on influencing policy change
Define Transformational leadership.
Discuss how Transformational Leadership may have an effect on influencing policy change
Critically analyze how healthcare systems and APRN practice are organized and influenced by ethical, legal, economic and political factors.
Demonstrate professional and personal growth concerning the advocacy role of the advanced practice nursing in fostering policy within diverse healthcare settings.
Advocate for institutional, local, national and international policies that fosters person-centered healthcare and nursing practice.
All writing submitted should reflect graduate student quality and APA writing rules. All writing informed by outside sources should include APA formatted citations and associated scholarly, current references. 1500 words
.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
2. effective.
This policy brief reviews the background
and current state of public and private pay-
for-performance initiatives. In theory, paying
providers for achieving better outcomes for
patients should improve those outcomes, but
in actuality, studies of these programs have
yielded mixed results. This brief also discuss-
es proposals for making these programs more
effective in the future.
w hat ’s the background?
For decades, policy makers have been con-
cerned with the incentive structure built into
the US health care system. The predominant
fee-for-service system under which providers
are paid leads to increased costs by rewarding
providers for the volume and complexity of
services they provide. Higher intensity of care
does not necessarily result in higher-quality
care, and can even be harmful.
m a n a g e d c a r e : During the 1990s payers
focused on managed care arrangements to
reduce excessive or unnecessary care, for ex-
ample, by paying providers by capitation, or
a lump sum per patient to cover a given set
of services. However, concerns about poten-
tially compromised quality and constraints
on patients having access to providers of their
choice led to a backlash from both providers
and consumers.
Also, by the early 2000s, serious deficien-
3. cies in the quality of US health care had been
highlighted in two major reports by the Insti-
tute of Medicine, among other studies. In this
context, pay-for-performance emerged as a
way for payers to focus on quality, with the ex-
pectation that doing so will also reduce costs.
The typical pay-for-performance program
provides a bonus to health care providers if
they meet or exceed agreed-upon quality or
performance measures, for example, reduc-
tions in hemoglobin A1c in diabetic patients.
The programs may also reward improvement
in performance over time, such as year-to-
year decreases in the rate of avoidable hospital
readmissions.
Pay-for-performance programs can also
impose financial penalties on providers that
2h e a l t h p o l i c y b r i e f p ay - f o r - p e r f o r m a n c e
fail to achieve specified goals or cost savings.
For example, the Medicare program no longer
pays hospitals to treat patients who acquire
certain preventable conditions during their
hospital stay, such as pressure sores or uri-
nar y tract infections associated with use of
catheters.
T he qua lit y measures used in pay-for-
performance generally fall into the four cat-
egories described below.
4. • Process measures assess the performance
of activities that have been demonstrated to
contribute to positive health outcomes for
patients. Examples include whether or not
aspirin was given to hear t attack patients
or whether patients were counseled to quit
smoking.
• Outcome measures refer to the effects
that care had on patients, for example, wheth-
er or not a patient’s diabetes is under control
based on laborator y tests. Use of outcome
measures is particularly controversial in pay-
for-performance because outcomes are often
affected by social and clinical factors unre-
lated to the treatment provided and beyond
the provider’s control. For example, provid-
ers may follow practice guidelines regarding
monitoring blood sugar levels and counsel-
ing diabetic patients regarding their diet, but
ultimately, the patients’ eating and exercise
behaviors will determine control of their dia-
betes. Increasingly, outcome measures also
include cost savings.
• Patient experience measures assess pa-
tients’ perception of the quality of care they
have received and their satisfaction with the
care experience. In the inpatient setting, ex-
amples include how patients perceived the
quality of communication with their doctors
and nurses and whether their rooms were
clean and quiet.
• Structure measures relate to the facilities,
personnel, and equipment used in treatment.
5. For example, many pay-for-performance pro-
grams offer incentives to providers to adopt
health information technology.
p r i vat e - s e c t o r i n i t i at i v e s : More than
40 private-sector pay-for-performance pro-
grams cur rently exist. One of the largest
and longest-running private-sector pay-for-
performance programs is the California Pay
for Performance Program, which is managed
by the Integrated Health Association, a non-
profit, multistakeholder group that promotes
quality improvement, accountability, and af-
fordability in health care. Founded in 2001,
the California Pay for Performance Program
is the largest physician incentive program in
the United States. It has focused on measures
related to improving quality performance by
physician groups and is transitioning to in-
clude value-based cost measures starting in
2014.
A more recent initiative is the Alternative
Quality Contract, which was implemented in
2009 between Blue Cross Blue Shield of Mas-
sachusetts and seven provider groups (since
increased to 11). Under the program, the pro-
viders receive a budget to take care of their
patients rather than payments for separate
services. The budget includes pay-for-perfor-
mance bonuses if certain quality targets are
met. In the first year of the program, a study by
Harvard Medical School researchers found re-
duced medical spending and improved quality
of patient care relative to a comparable group
6. of providers paid through the traditional fee-
for-service approach.
p u b l i c - s e c t o r i n i t i at i v e s : In the public
sector, the Centers for Medicare and Medicaid
Services (CMS) has established a Value-Based
Purchasing Program to provide incentives
for physicians and providers to improve the
quality and efficiency of care (Exhibit 1). CMS
has also been involved in a number of pay-for-
performance demonstration projects testing a
variety of approaches among different catego-
ries of providers.
The largest and most notable of these has
been the Premier Hospital Quality Incentive
Demonstration project. From 2003 to 2009,
CMS and Premier, a nationw ide hospital
system, tested the extent to which financial
bonuses would improve the qualit y of care
provided to Medicare patients with certain
conditions, including acute myocardial in-
farction, heart failure, and pneumonia.
Another major CMS demonstration was the
Physician Group Practice Demonstration, a
program in which group practices could share
cost savings with Medicare as long as they met
targets for quality of care. Results of these ini-
tiatives are discussed below.
Many states have also experimented with
pay-for-performance in their Medicaid and
Children’s Health Insurance Program ini-
tiatives. One of the largest of these has been
the Massachusetts Medicaid’s hospital-based
7. pay-for-performance program, which was ini-
40+
Private-sector programs
M o re t ha n 4 0 pr iva te -
sec to r pay -fo r- per fo r ma n ce
pro g ra ms cu r ren tly e xis t .
“The typical pay-
for-performance
program provides
a bonus to health
care providers
if they meet or
exceed agreed-
upon quality or
performance
measures.”
3h e a l t h p o l i c y b r i e f p ay - f o r - p e r f o r m a n c e
tiated in 2008. Under this program, hospitals
received incentive payments based on their
scores for a set of quality indicators related to
care for pneumonia (for example, providing
antibiotics within six hours of arrival) and
surgical infection prevention (for example,
giving prophylactic antibiotics within one
hour of surgical incision).
Most early pay-for-perfor mance experi-
ments narrowly focused on “quality” with very
little, if any, consideration of cost. However,
the field has been evolving and many pro-
8. grams now address overall value by incorpo-
rating both quality and cost as major design
elements. The Affordable Care Act, in fact,
explicitly pushes CMS in this direction, as ex-
plained below.
w hat ’s in the l aw?
The Affordable Care Act includes a number of
provisions designed to encourage improve-
ments in the quality of care. Some are not,
strictly speaking, pay-for-performance pro-
grams. For example, Medicare’s Hospital Re-
admissions Reduction Program, which took
effect on October 1, 2012, can reduce pay-
ments by 1 percent to hospitals that have ex-
cessively high rates of avoidable readmissions
for patients experiencing heart attacks, heart
failure, or pneumonia.
Perhaps the best known of the programs
under the law that will pay for performance
are accountable care organizations (ACOs)—
groups of providers that agree to coordinate
care and to be held accountable for the qual-
ity and costs of the services they provide. (See
the Health Policy Brief published on January
31, 2012, for more information on Medicare
ACO demonstration projects.) Three other
programs are described below.
• Value-based purchasing. The A fford-
able Care Act also expands pay-for-perfor-
mance efforts in hospitals by establishing a
Hospital Value-Based Purchasing Program.
Starting October 1, 2012, hospitals will be re-
9. warded for how well they perform on a set of
quality measures as well as on how much they
improve in performance relative to a baseline.
The better a hospital does on its quality mea-
sures, the greater the reward it will receive.
The law also requires CMS to develop value-
based purchasing programs for home health
agencies; skilled nursing facilities; ambula-
tor y surgical centers; specialt y hospitals,
such as long-term care facilities; and hospice
programs.
• Physic ia n qu a l it y re por t i ng. T he
health care law also extends through 2014
the Medicare Physician Qualit y Reporting
System that provides financial incentives to
physicians for reporting quality data to CMS.
Beginning in 2015 the incentive payments
will be eliminated, and physicians who do
not satisfactorily report quality data will see
their payments from Medicare reduced. (See
the Health Policy Brief published on March 8,
2012, for more information on public report-
ing of quality and costs.)
• Medicare Advantage plan bonuses. The
Affordable Care Act also provides for bonus
payments to Medicare Advantage plans that
achieve at least a four-star rating on a five-star
qualit y rating scale, beginning in 2012. In
November 2010 CMS announced that it would
replace this provision with a demonstration
project in which bonus payments would be
awarded to Medicare Advantage plans that
have at least an average of three stars and
would increase the size of bonuses for plans
10. with four or more stars.
w hat are the concerns?
Studies on the effects of pay-for-performance
have found mixed results. For example, a
study of the Premier Hospital Quality Incen-
tive Demonstration project mentioned ear-
lier, led by Rachel M. Werner at the University
of Pennsylvania, found that hospitals in the
<1%
Change in payments
Medic a re’s Hospital Value -
B ased P u rchasing P ro g ra m w ill
alter pay m en t s to alm os t t wo -
t hirds of acu te c a re h ospitals
by o nly a f rac tio n of 1 percen t .
exhibit 1
Overall Goals of Value-Based Purchasing in Medicare
Fina n cial v ia bilit y T h e f ina n cial v ia bilit y of t h e t
raditio nal Medic a re fee -
fo r- ser v ice pro g ra m is protec ted fo r ben e f icia r ies a
nd
ta x payer s
Pay m en t in cen tives Medic a re pay m en t s a re lin ked to t
h e value (q ualit y a nd
e f f icien c y) of c a re
Join t acco u n ta bilit y P rov ider s have join t clinic al a n d f
ina n cial acco u n ta bilit y
fo r h ealt h c a re in t h eir co m m u nities
11. Ef fec tiven ess Ca re is ev iden ce based a nd o u tco m es d r
iven to be t ter
ma nage diseases
Ensu r ing access Res t r uc t u red fee -fo r- ser v ice s ys tem
prov ides ensu red
access to hi g h - q ualit y, a f fo rda ble c a re
S a fe t y, t ra nspa ren c y B en e f icia r ies receive in fo r ma
tio n o n t h e q ualit y, cos t , a nd
s a fe t y of t h eir c a re
Sm oot h t ra nsitio ns Pay m en t s ys tems su ppo r t well- coo
rdina ted c a re across
prov ider s a nd se t ting s
Im proved tech n olo g y Elec t ro nic h ealt h reco rds h elp
prov ider s deliver hi g h -
q ualit y, e f f icien t , a nd coo rdina ted c a re
s o u r c e Ce n te r s fo r M e dic a r e a n d M e dic aid S e r v
ice s .
http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolic
ybrief_61.pdf
http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolic
ybrief_65.pdf
4h e a l t h p o l i c y b r i e f p ay - f o r - p e r f o r m a n c e
demonstration initially showed promising
improvements in quality compared to a con-
trol group. However, the effects were short
lived, and after the fifth year of the demon-
stration, there were no significant differences
12. in performance scores between participating
hospitals and a comparison group of hospitals
not in the project (Exhibit 2). A possible ex-
planation is that performance was improving
broadly across all hospitals, as discussed more
fully below.
A separate study of the Medicare Premier
Hospital Qualit y Incentive demonstration
program, led by Ashish Jha of the Har vard
School of Public Health, analyzed 30-day mor-
tality rates for patients with acute myocardial
infarction, congestive heart failure, pneumo-
nia, or coronary artery bypass graft surgery
between 2004 and 2009. The results showed
no difference in mortality rates between hos-
pitals in the Premier demonstration and a con-
trol group of nonparticipating hospitals.
As noted, one possible explanation for the
lack of difference between participating hospi-
tals and comparison groups was due to anoth-
er CMS policy inter vention—namely, public
reporting of hospital performance—which
may have motivated hospitals broadly to im-
prove their performance. While the Premier
demonstration was under way, the Depart-
ment of Health and Human Services rolled out
its Hospital Compare website, which publicly
reports quality-of-care measures at more than
4,000 Medicare-certified hospitals.
Many hospitals reportedly worried about
being publicly “shamed” if they displayed poor
performance, and so they endeavored to close
13. the quality gap. Many hospital administrators
surveyed by researchers at the RAND Corpora-
tion also said they began to “shadow” the Pre-
mier demo and make improvements on their
own, anticipating that CMS would implement
pay-for-performance across all hospitals.
c h a l l e n g e s i n d e s i g n : In another study
assessing the likely effects of Medicare’s
Hospital Value-Based Purchasing Program,
Werner and coauthors calculated that pay-
ments to almost two-thirds of acute care hos-
pitals will be altered by only a fraction of 1
percent. This low of an incentive, she and col-
leagues wrote, raises questions about whether
the program will substantially alter the qual-
ity of hospital care.
Similarly, Andrew M. Ryan at Cornell Uni-
versity and colleagues studied the first years
of the Massachusetts Medicaid hospital pay-
for-per for mance program, which offered
financial incentives for improving care for
pneumonia and prevention of surgical infec-
tions, and found no improvement in quality.
Another study led by Steven D. Pearson of Mas-
sachusetts General Hospital compared quality
performance among Massachusetts’ physician
group practices during 2001–03 and found
improvement in quality measures across all
of the medical groups, regardless of whether
or not pay-for-performance incentives were in
place. The amount of improvement was con-
sistent with what occurred nationally during
the same time period.
14. Suzanne Felt-Lisk of Mat hematica Pol-
ic y Research conducted a st udy of seven
Medicaid-focused health plans in California
from 2002 to 2005, and found that paying fi-
nancial bonuses to physicians for improving
well-child care did not produce significant
effects in the majority of participating health
plans. The lack of success was attributed to
particular characteristics of the Medicaid pro-
gram, such as enrollees’ lack of transportation
and limited staff capacity to do outreach.
Showing greater success, researchers at
Dartmouth College and the National Bureau
for Economic Research recently analyzed re-
sults of the Medicare Physician Group Practice
Demonstration, a pilot project that ran from
2005 to 2010. In the demonstration, doctors
15%
Dual- eligible beneficiaries
Cos t red uc tio ns in t h e
Medic a re P hysicia n G ro u p
P rac tice Dem o ns t ra tio n were
g rea tes t fo r t h e 15 percen t of
ben e f icia r ies w h o were eli g ible
fo r bot h Medic aid
a nd Medica re.
e x h i b i t 2
Average Overall Performance in Pay-for- Performance and
Control Hospitals,
Fiscal Years 2004–08
s o u r c e R a c h el M . We r n e r, Jo n a t h a n T. Kol s ta d ,
15. Eli z a b e t h A . St u a r t , a n d Da n iel Pol sk y, “ T h e Ef
fe c t o f
Pay -fo r- Pe r fo r m a n ce i n H o spi tal s : Le ss o n s fo r Q
u ali t y Im p r ove m e n t ,” H ea lth Af fa i rs 30, n o. 4
(2011) :
690 – 8. Da ta f r o m H o spi tal Co m p a r e : s u r vey o f p a
t ie n t s ’ h o spi tal e x p e r ie n ce s [i n te r n e t] , D e p a r t
m e n t
o f H e al t h a n d H u m a n S e r v ice s . n o t e s Pe r fo r m a
n ce i s ave r a ge d a c r o ss t h e t h r e e co n di t io n s : a c u
te
m yo c a rdial i n fa rc t io n , h e a r t failu r e , a n d p n e u m
o n ia . T h e v alu e s sh ow n a r e ave r a ge co m p o si te
p e r fo r m a n ce s co r e s .
O
ve
ra
ll
ho
sp
it
al
p
er
fo
rm
an
ce
16. 100
95
90
85
80
75
Q4 Q1 Q2 Q3
Pay-for-performance
Control
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2003 2004 2005 2006 2007 2008
Q1 Q2 Q3 Q4 Q1 Q2 Q3
http://www.hospitalcompare.hhs.gov/
5h e a l t h p o l i c y b r i e f p ay - f o r - p e r f o r m a n c e
in 10 large physician group practices received
bonuses if they achieved lower cost growth
than local controls and met quality targets.
The researchers found an improvement in
quality but modest reduction in the growth
of spending for most Medicare beneficiaries.
Cost reductions were greatest for the 15 per-
17. cent of patients who were dual eligibles, typi-
cally low-income people who qualify for both
Medicaid and Medicare and who often have
complex, chronic conditions.
p ay e r - p r o v i d e r c o n t r o v e r s y : Despite
limited evidence of effectiveness, pay-for-
performance remains popular among policy
makers and public and private insurers as a
tool for improving quality of care and contain-
ing health care costs.
Supporters of pay-for-performance point
out that their primary goal has been measur-
ing the quality of care and motivating provid-
ers to improve it. The element of lowering
cost has been included only recently in many
of these arrangements. Now, supporters say,
measuring both quality and cost is important,
in part to ensure that quality doesn’t decline
even as costs are lowered.
Some providers, however, have tended to
be skeptical of pay-for-performance arrange-
ments. Although they don’t disagree with the
need to focus on quality improvement, they
are concerned that the underlying goal of pay-
for-performance is cost containment at the ex-
pense of patient care. They recall, for example,
the consumer backlash against managed care
with its focus on restraining spending with
little or no monitoring of quality.
Another issue for providers is the cost of
adopting the health information technology
needed for data collection and reporting. The
18. American Academy of Family Physicians has
stated that pay-for-performance incentives
must be large enough to allow physicians to
recoup their additional administrative costs
as well as provide significant incentives for
quality improvement.
Other professional societies are actively
engaged in inf luencing the design of pay-for-
performance programs and monitoring their
implementation. The American Medical As-
sociation has developed principles for pay-
for-performance programs emphasizing that
provider participation should be voluntar y;
that physicians should be allowed to review,
comment, and appeal performance data; and
that programs should use new funding “for
positive incentives to physicians for their
participation.”
s a f e t y - n e t p r ov i d e r s : Serious concerns
have been raised about the impact of pay-for-
performance approaches on poorer and dis-
advantaged populations. In particular, there
are fears that these programs may exacerbate
racial and ethnic disparities in health if pro-
viders avoid patients that are likely to lower
their performance scores.
A study by A lyna Chien at Weill Cornell
Medical College found that medical groups
caring for patients in lower-income areas of
California received lower pay-for-performance
scores than others. The reasons were attribut-
ed to serving patients who had both language
19. barriers as well as limited access to transpor-
tation, child care, or other resources.
Similarly, a study by Jha and colleagues
of costs and quality in US hospitals found a
group that consistently performed worse on
both quality and cost metrics and that cares
for proportionally greater numbers of elderly
black and Medicaid patients than other insti-
tutions. Many of these hospitals also have low
or zero margins. If they were to lose even 1 per-
cent of Medicare reimbursement through the
value-based purchasing program, the authors
wrote, the impact would be severe, and care
for the populations these institutions ser ve
could be jeopardized.
Another analysis of Medicare data by Kai-
ser Health News showed that hospitals that
treat large numbers of low-income patients
will be hit especially hard from penalties for
having overly high ratios of avoidable hospital
readmissions. Safety-net hospitals argue that
their higher readmission rates ref lect their
patients’ poor access to physicians and medi-
cations. CMS argues, on the other hand, that
many safety-net providers outperform hos-
pitals that do not treat significant numbers
of low-income patients. This premise is sup-
ported by a recent study by Yale researchers
that found similar mortality and readmission
rates between safety-net and non-safety-net
hospitals.
w hat ’s ne x t?
Pay-for-performance programs are likely to
20. expand across US health care in the near fu-
ture, especially with implementation of the
Affordable Care Act. But experience to date
w it h pay-for-per for mance initiatives has
“Despite limited
evidence of
effectiveness,
pay-for-
performance
remains popular
among policy
makers and
public and
private insurers.”
1%
Hospital payment penalty
Sta r ting Oc to ber 1, 2 0 12 , t h e
Cen ter s fo r Medic a re a nd
Medic aid S er v ices c a n red uce
pay m en t s by 1 percen t to
h ospitals w h ose read missio n
ra tes fo r pa tien t s w it h cer tain
co nditio ns e xceed a pa r ticula r
ta r ge t .
6h e a l t h p o l i c y b r i e f p ay - f o r - p e r f o r m a n c e
Alliance for Health Reform, “Pay-for-Performance: A
Promising Start,” February 2006.
C h ien, A ly n a T., K r isten Wroble wsk i, C her yl
Damberg, Thomas R. Williams, Dolores Yanagihara,
21. Yelena Yakunina, and Lawrence P. Casalino, “Do Phy-
sician Organizations Located in Lower Socioeconom-
ic Status Areas Score Lower on Pay-for-Performance
Measures?” Journal of General Internal Medicine 27,
no. 5 (2012): 548–54.
Felt-Lisk, Suzanne, Gilbert Gimm, and Stephanie
Peterson, “Making Pay-for-Performance Work in
Medicaid,” Health Affairs 26, no. 4 (2007): w516–27.
Jha, Ashish K., E. John Orav, and Arnold M. Epstein,
“Low-Quality, High-Cost Hospitals, Mainly in South,
Care for Sharply Higher Shares of Elderly Black, His-
panic, and Medicaid Patients,” Health Affairs 30, no.
10 (2011): 1904–11.
Mu l len, K at h leen J., R ic h a rd G. Fr a n k, a nd
Meredith B. Rosenthal, “Can You Get What You Pay
for? Pay-for-Performance and the Quality of Health-
care Providers,” National Bureau of Economic Re-
search, Working Paper 14886, April 2009.
Pea rson, Steven D., Er ic C . Sch neider, Ken P.
Kleinman, Kathryn L. Coltin, and Janice A. Singer,
“The Impact of Pay-for-Performance on Health Care
Quality in Massachusetts, 2001–2003,” HealthAffairs
27, no. 4 (2008): 1167–76.
Rau, Jordan, “Medicare to Penalize 2,211 Hospitals
for Excess Readmissions,” Kaiser Health News, Au-
gust 13, 2012.
Ryan, Andrew M., and Jan Blustein, “The Effect of
the MassHealth Hospital Pay-for-Performance Pro-
gram on Quality,” Health Ser vices Research 46, no. 3
(June 2011): 712–28.
22. Ryan, A ndrew M., Jan Blustein, and Law rence P.
Casa lino, “Medicare’s F lagship Test of Pay-for-
Per for mance Did Not Spur More Rapid Qualit y
Improvement among Low-Performing Hospitals,”
Health Affairs 31, no. 4 (2012): 797–805.
Werner, Rachel, and R. Adams Dudley, “Medicare’s
New Hospital Value-Based Purchasing Program Is
Likely to Have Only a Small Impact on Hospital Pay-
ments,” Health Affairs 31, no. 9 (2012): 1932–40.
Werner, Rachel, Jonathan T. Kolstad, Elizabeth A.
Stuart, and Daniel Polsky, “The Effect of Pay-for-
Performance in Hospitals: Lessons for Quality Im-
provement,” Health Affairs 30, no. 4 (2011): 690–8.
resources
A b o u t H e a lt h P o li c y B r i e f s
Writ ten by
J u li a J a m e s
( J a m e s p r e v i o u s l y w o r k e d o n
C a p i t o l H i l l a n d a s a c o n s u l t a n t i n
Wa s h i n g t o n , D.C . , a n d O r e g o n . )
Editorial review by
C h e r y l L . D a m b e r g
Senior Policy Researcher
R AND Corporation
Andrew M. Ryan
Assistant Professor
Weill Cornell Medical College
23. Ted Agres
Senior Editor for Special Content
Health Affairs
Anne Schwartz
Deput y Editor
Health Affairs
S u s a n D e n t z e r
Editor-in-Chief
Health Affairs
Health Policy Briefs are produced
under a par tnership of Health Affairs
and the Rober t Wood Johnson
Foundation.
Cite as:
“Health Policy Brief: Pay-for-
Per formance,” Health Affairs,
October 11, 2012.
Sign up for free policy briefs at:
w w w.healthaf fairs.org /
healthpolicybriefs
raised a number of questions that require
more research and experimentation.
For example, how large do rewards need
to be to produce desired changes? How often
should rewards be distributed? How can im-
provements in performance become sustained
over time? How can provider acceptance best
be gained and maintained? What impact will
these programs have on health systems that
24. are weak financially or that serve greater pro-
portions of racial and ethnic minorities?
As with any emerging reform tool, research-
ers say, experimentation with pay-for-perfor-
mance programs should include thoughtful
monitoring and evaluation to identify design
elements that positively affect outcomes. Eval-
uation of these programs should take into ac-
count variations in health care markets, such
as in the supply of providers, and should in-
clude control or comparison groups so that the
effects of pay-for-performance can be isolated
from other factors.
Evaluations will also need to be conducted
over sufficiently long time periods to identify
any unintended consequences, such as long-
term effects on vulnerable populations.n
http://www.healthaffairs.org/healthpolicybriefs
http://www.allhealth.org/publications/pub_4.pdf
http://www.springerlink.com/content/p212v136335v8662/
http://content.healthaffairs.org/content/26/4/w516.abstract
http://content.healthaffairs.org/content/30/10/1904.abstract
http://www.nber.org/papers/w14886.pdf
http://content.healthaffairs.org/content/27/4/1167.abstract
http://www.kaiserhealthnews.org/Stories/2012/August/13/medic
are-hospitals-readmissions-penalties.aspx
http://onlinelibrary.wiley.com/doi/10.1111/j.1475-
6773.2010.01224.x/abstract
http://content.healthaffairs.org/content/31/4/797.abstract
http://content.healthaffairs.org/content/31/9/1932.abstract
http://content.healthaffairs.org/content/30/4/690.abstract
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Author, A. A., Second, B. B., & Third, C. C. (2012). Title of
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