Has Pay-for-Performance Decreased Access for Minority Patients? Essay Example

Introduction

Patients and practitioners are primarily concerned with being provided and providing quality care. Recently, patients have been empowered with information that helps them make informed decisions about choosing the best care facilities (CMS, 2014). Patients now have the ability to compare how other patients have rated the services they received at facilities. Medicaid & Medicare services has been collecting and reporting information about patient’s perception of services they are receiving. These reports are made public.

Hospital Based Pay

The United States Health Care System reimbursement model has been under transformation in recent years. One of the changes that has been made is a hospital-based pay for performance (P4P). The Affordable Care Act authorized the establishment of the P4P as an initiative for facilities to provide better quality services. Accordingly, the program was created to “transform CMS from a passive payer of claims to an active purchaser of care” (Messner, 2012). This a new concept that rewards hospitals based upon their performance as set forth by the CMS performance measure standards (Ryan, 2013). Patients are surveyed to determine how they rate the services they received at the facility. Consequently, the identification of low-performing and high-performing facilities has been made. Low performing facilities have had reductions in their reimbursement rates. Those facilities that choose not to participate in patient satisfaction surveys will receive less Medicare reimbursement altogether. Ryan added that the P4P program is important because the patient’s preference and perception can be adequately measured to insure patient satisfaction (2013).

Hospital Acquired Infection

Hospital-acquired infections have been on the rise according to the CMS. Beginning in early October, CMS has compiled a “do not pay” list which includes not paying for hospital errors, injuries, and infections that are deemed preventable (Zhang, Donohue, Lave, O’Donnell & Newhouse, 2013) .There are eight conditions listed: catheter-associated urinary tract infection, vascular catheter-associated infections, surgical site infections, Legionnaires’ disease, Staphylococcus aureaus septicemia, Clostridium difficile-associated disease, and ventilator-associated pneumonia. Although this may prove a difficult issue for patients, it ensures that they are receiving quality care. When facilities know that it will not be reimbursed for issues that can be prevented, healthcare workers will be more careful to ensure that errors do not occur.

Benefits for Stakeholders

Many patients and physicians agree that the benefits of the guidelines enacted by CMS greatly outweigh the barriers (CMS, 2014). When electronic the CMS guidelines are properly implemented patients will see an improvement in quality and convenience, improved accuracy in diagnoses, and improved coordination of care. Physicians will ensure that they have accurate up-to-date medical records for their patients which allows for speedier prognoses and recovery processes, while ensuring that tests and evaluations are necessary prior to scheduling them. One of the greatest benefits of the CMS system is it gives patients access to satisfaction surveys for the facilities they may use.  . This helps patients become aware of potential problems that could lead to more serious consequences or even death. Another benefit CMS is less billing errors. Patients have often complained of being charged for services they have not received. CMS restrictions have been proven very effective in handling billing charges. Patients feel more confident that they will be accurately billed preventable (Zhang, Donohue, Lave, O’Donnell & Newhouse, 2013). Finally, CMS ensures coordinated care. Many patients have more than one physician. The use of this system ensures that proper communication occurs between all parties because each facility wants to ensure that it is being properly reimbursed.

References

CMS (2014).  HCAHPS: Patients’ perspective of care survey.  Retrieved December 16, 2014 from http://www.cms.gov/HospitalQualityInits/30_HospitalHCAHPS.asp

Messner, E. R. (2012).  Quality of care and patient satisfaction: the improvement effort of one emergency department.  Topics in Emergency Medicine, 27(2), 132 – 142.

Ryan. A. M. (2013).  Has Pay-for-Performance decreased access for minority patients? Health Research and Educational Trust 45(1), 6 – 23.

Zhang, Y., Donohue, J. M., Lave, J. R., O’Donnell, G. & Newhouse, J. P. (2013). The effect of Medicare Part D on drug and medical spending. New England Journal of Medicine, 361 (1), 52-61.