The Provider's Guide to Value-Based Medicare Reimbursement is organized into groupings of chapters of related programs and initiatives most pertinent to a specific provider type. Parts I and II cover Medicare value-based programs for hospitals and physicians respectively. Part III is dedicated to new and emerging care-coordination healthcare delivery models contained in the PPACA which impact both hospitals and physicians.
The decade ahead will test the nation's nearly 4 million nurses in new and complex ways. Nurses live and work at the intersection of health, education, and communities. Nurses work in a wide array of settings and practice at a range of professional levels. They are often the first and most frequent line of contact with people of all backgrounds and experiences seeking care and they represent the largest of the health care professions. A nation cannot fully thrive until everyone - no matter who they are, where they live, or how much money they make - can live their healthiest possible life, and helping people live their healthiest life is and has always been the essential role of nurses. Nurses have a critical role to play in achieving the goal of health equity, but they need robust education, supportive work environments, and autonomy. Accordingly, at the request of the Robert Wood Johnson Foundation, on behalf of the National Academy of Medicine, an ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine conducted a study aimed at envisioning and charting a path forward for the nursing profession to help reduce inequities in people's ability to achieve their full health potential. The ultimate goal is the achievement of health equity in the United States built on strengthened nursing capacity and expertise. By leveraging these attributes, nursing will help to create and contribute comprehensively to equitable public health and health care systems that are designed to work for everyone. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity explores how nurses can work to reduce health disparities and promote equity, while keeping costs at bay, utilizing technology, and maintaining patient and family-focused care into 2030. This work builds on the foundation set out by The Future of Nursing: Leading Change, Advancing Health (2011) report.
Recent health care payment reforms aim to improve the alignment of Medicare payment strategies with goals to improve the quality of care provided, patient experiences with health care, and health outcomes, while also controlling costs. These efforts move Medicare away from the volume-based payment of traditional fee-for-service models and toward value-based purchasing, in which cost control is an explicit goal in addition to clinical and quality goals. Specific payment strategies include pay-for-performance and other quality incentive programs that tie financial rewards and sanctions to the quality and efficiency of care provided and accountable care organizations in which health care providers are held accountable for both the quality and cost of the care they deliver. Accounting For Social Risk Factors in Medicare Payment: Data is the fourth in a series of five brief reports that aim to inform ASPE analyses that account for social risk factors in Medicare payment programs mandated through the IMPACT Act. This report provides guidance on data sources for and strategies to collect data on indicators of social risk factors that could be accounted for Medicare quality measurement and payment programs.
America's health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation's economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at a lower cost. The costs of the system's current inefficiency underscore the urgent need for a systemwide transformation. About 30 percent of health spending in 2009-roughly $750 billion-was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state. This report states that the way health care providers currently train, practice, and learn new information cannot keep pace with the flood of research discoveries and technological advances. About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions, and dangerous drug interactions. Best Care at Lower Cost emphasizes that a better use of data is a critical element of a continuously improving health system, such as mobile technologies and electronic health records that offer significant potential to capture and share health data better. In order for this to occur, the National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care. This book is a call to action that will guide health care providers; administrators; caregivers; policy makers; health professionals; federal, state, and local government agencies; private and public health organizations; and educational institutions.
The United States has the highest per capita spending on health care of any industrialized nation but continually lags behind other nations in health care outcomes including life expectancy and infant mortality. National health expenditures are projected to exceed $2.5 trillion in 2009. Given healthcare's direct impact on the economy, there is a critical need to control health care spending. According to The Health Imperative: Lowering Costs and Improving Outcomes, the costs of health care have strained the federal budget, and negatively affected state governments, the private sector and individuals. Healthcare expenditures have restricted the ability of state and local governments to fund other priorities and have contributed to slowing growth in wages and jobs in the private sector. Moreover, the number of uninsured has risen from 45.7 million in 2007 to 46.3 million in 2008. The Health Imperative: Lowering Costs and Improving Outcomes identifies a number of factors driving expenditure growth including scientific uncertainty, perverse economic and practice incentives, system fragmentation, lack of patient involvement, and under-investment in population health. Experts discussed key levers for catalyzing transformation of the delivery system. A few included streamlined health insurance regulation, administrative simplification and clarification and quality and consistency in treatment. The book is an excellent guide for policymakers at all levels of government, as well as private sector healthcare workers.
Promising Care: How We Can Rescue Health Care by Improving It collects 16 speeches given over a period of 10 years by Donald M. Berwick, an internationally acclaimed champion of health care improvement throughout the course of his long and storied career as a physician, health care educator and policy expert, leader of the Institute for Healthcare Improvement (IHI), and administrator of the Centers for Medicare & Medicaid Services. These landmark speeches (including all of Berwick’s speeches delivered at IHI’s annual National Forum on Quality Improvement in Health Care from 2003 to 2012) clearly show why our medical systems don’t reliably contribute to our overall health. As a remedy he offers a vision for making our systems better – safer, more effective, more efficient, and more humane. Each of Berwick’s compelling speeches is preceded by a brief commentary by a prominent figure in health care, policy, or politics who has a unique connection to that particular speech. Contributors include such notables as Tom Daschle, Paul Batalden, and Lord Nigel Crisp. Their commentaries reflect on how it felt to hear the speech in the context in which it was delivered, and assess its relevance in today’s health care environment. The introduction is by Maureen Bisognano, CEO of Institute for Healthcare Improvement, and author of Pursuing the Triple Aim. Praise for previous books by Don Berwick Curing Health Care: "The book is an easy and affirming read for anyone who is familiar with and has used the TQM teachings of Dr. Joseph M. Juran and Dr. W. Edwards Deming and would be a simple and informative introduction to the concepts for anyone who has been hearing about TQM but has no idea what it is all about and wants to know more." —Permanent Fixes (blog) "Donald Berwick is the most clearly heard evangelist of applying industrial methods of continuous quality improvement in health care." —Annals of Internal Medicine Escape Fire: "With an effective blend of common sense, real-life stories, persuasive metaphors, and out-of-the-box thinking, Dr. Berwick’s presentations make for fascinating reading for anyone interested in improving America’s $1.7 trillion health care system." —Piper Report "Anyone interested in change in the healthcare system would enjoy this book. In degree programs, the various speeches would be useful for discussion in a health policy readings course." —The Annals of Pharmacotherapy
The third installment in the Pathways to Quality Health Care series, Rewarding Provider Performance: Aligning Incentives in Medicare, continues to address the timely topic of the quality of health care in America. Each volume in the series effectively evaluates specific policy approaches within the context of improving the current operational framework of the health care system. The theme of this particular book is the staged introduction of pay for performance into Medicare. Pay for performance is a strategy that financially rewards health care providers for delivering high-quality care. Building on the findings and recommendations described in the two companion editions, Performance Measurement and Medicare's Quality Improvement Organization Program, this book offers options for implementing payment incentives to provide better value for America's health care investments. This book features conclusions and recommendations that will be useful to all stakeholders concerned with improving the quality and performance of the nation's health care system in both the public and private sectors.
Provide outstanding healthcare while keeping within budget with this comprehensive, engagingly written guide Understanding Value-Based Healthcare is a succinct, interestingly written primer on the core issues involved in maximizing the efficacy and outcomes of medical care when cost is a factor in the decision-making process. Written by internationally recognized experts on cost- and value-based healthcare, this timely book delivers practical and clinically focused guidance on one of the most debated topics in medicine and medicine administration today. Understanding Value-Based Healthcare is divided into three sections: Section 1 Introduction to Value in Healthcare lays the groundwork for understanding this complex topic. Coverage includes the current state of healthcare costs and waste in the USA, the challenges of understanding healthcare pricing, ethics of cost-conscious care, and more. Section 2 Causes of Waste covers important issues such as variation in resource utilization, the role of technology diffusion, lost opportunities to deliver value, and barriers to providing high-value care. Section 3 Solutions and Tools discusses teaching cost awareness and evidence-based medicine, the role of patients, high-value medication prescribing, screening and prevention, incentives, and implementing value-based initiatives. The authors include valuable case studies within each chapter to demonstrate how the material relates to real-world situations faced by clinicians on a daily basis. .
