Accountability in Healthcare

Accountability in Healthcare

The US healthcare system is facing significant financial pressures amidst the ever-increasing demands for quality, timely, effective, and efficient care. According to Genovese et al. (2017), accountability in healthcare is a profound concept that enshrines interdisciplinary collaboration, shared responsibility, transparency, credibility, reliability, and error prevention.

Accountability in Healthcare

The primary purposes of integrating accountability in healthcare are to reduce care costs, ensure responsible and sustainable resource utilization, and improve care quality by emphasizing services’ value. This paper elaborates on Accountable Health Organizations (ACOs), the role of health information technology (HIT) in new care models, and reimbursement models that improve care quality.

An Accountable Care Organization (ACO) and its Impacts on Healthcare Providers

The United States federal government invests massively in the healthcare sector to achieve the overarching objectives of reducing health disparities, tackling the challenges of acute and chronic diseases, and improving people’s health and well-being.

However, the country’s healthcare system faces multiple challenges, including ever-increasing care costs that compromise care quality. As a result, these constraints necessitate accountability in healthcare by prompting healthcare professionals and stakeholders like doctors, caregivers, and hospitals to collaborate in pursuing a collective course of ensuring high-quality healthcare services.

For instance, the interdisciplinary and multi-agency collaboration led to the formation of Accountable Health Organizations (ACOs). According to Gossman et al. (2022), an Accountable Health Organization (ACO) is an entity consisting of responsibly-integrated healthcare providers that work together to achieve a common clinical goal and outcome. In this sense, ACOs target various dimensions of care quality, including efficiency and patient-centeredness.

Accountable Health Organizations (ACOs) impact healthcare professionals by prompting them to work together in ensuring care efficiency and quality. Gossman et al. (2022) contend that ACOs operate in three profound tenets; leading provider-led organizations with a strong base of primary care that is accountable for the quality and per Capita costs, payments linked to improved quality and reduced costs, and adopting reliable and increasingly sophisticated performance measurements to support quality improvement and ensure cost saving. These principles enable healthcare providers to enhance team performance and coordinate services consistent with quality care delivery.

How do ACOs differ from the health maintenance organizations (HMOs) of earlier years?

Accountable Health Organizations (ACOs) bring together healthcare professionals and stakeholders to provide quality care, reduce per capita costs, implement payment models consisting of improved quality and reduced costs, and establish performance measurements to support quality improvement.

According to Falkson & Srinivasan (2022), ACOs differ from health maintenance organizations (HMOs) in the sense that HMOs are insurance groups that are in contract with clinicians, while ACOs consist of clinician groups in contract with insurers.

Apart from this structural difference, the two entities vary in terms of when a patient can approach and access healthcare professionals. For ACOs, patients face minimal restrictions when accessing care providers and do not need to enroll in any ACO program to benefit from healthcare services (Berkovich & Sitapati, 2019).

On the other hand, HMOs require patients’ pre-authorization before proceeding to healthcare organizations. Finally, HMOs provide services like insurance companies, while the primary goal of ACOs is to coordinate care to ensure that patients have access to timely care, free from unnecessary duplications and medical errors.

What role does health information technology (HIT) play in the new models of care?

New care delivery models, such as value-based care and pay-for-performance (P4P), emphasize care services that fulfill various quality dimensions, including patient-centeredness, cost-effectiveness, timeliness, and efficiency. Undeniably, healthcare organizations are responsible for transforming infrastructure and processes to achieve these objectives.

As a result, incorporating health information technology (HIT) into care delivery emerges as a profound strategy for supporting new models of care. According to Alotaibi & Federico (2017), HIT entails the application of information processing that involves computer hardware and software for dealing with data storage, retrieval, and sharing. Examples of health information technology (HIT) include simple charting, clinical decision support systems (CDSSs), and electronic health record systems (EHRS).

Alotaibi & Federico (2017) add that these technologies present limitless opportunities for improving and transforming healthcare, including reducing human errors, facilitating care coordination, enabling overtime data tracking, enhancing clinical outcomes, and bolstering practice efficiencies.

Besides these benefits, health information technology (HIT) increases speed in hospitals by facilitating information interoperability and effective dissemination of protected health information. According to Alotaibi & Federico (2017), technologies like clinical decision support systems provide healthcare professionals with patient-specific information, including notifications, alerts, and reminders, enabling care providers to prevent adverse events and improve health outcomes.

The concept of information interoperability contributes to increased collaboration and interconnection between healthcare agencies, prompting system-based care delivery. In this sense, the possibility of sharing information via health information technology devices prevents care fragmentation and delays that compromise care quality and utilization.

What is the benefit of hospitals partnering with primary care providers?

Interdisciplinary collaboration and partnerships with primary care providers result in multiple benefits to hospitals. For instance, partnering with primary care providers such as nurses and physicians results in the formation of Accountable Care Organizations (ACOs) that enables healthcare professionals to pursue collective goals of improving care quality, efficiency, convenience, and timeliness.

Another benefit of partnering with primary care providers is the effective implementation of health information technology (HIT). Successful incorporation of HITs into clinical practices leads to improved processes, timely delivery of healthcare services, process accuracy, and enhanced outcomes.

How do bundling payments contain healthcare costs?

Bundling payments is an ideal alternative reimbursement model for the fee-for-service (FFS) strategy. The method reimburses healthcare providers based on the expected costs of clinically-defined episodes of care. According to Hardin et al. (2017), the Centers for Medicare and Medicaid Services (CMS) introduced the bundled payments for care improvement (BPCI) initiative in 2011 as a strategy for improving healthcare delivery for patients before and after discharge.

Bundled payments can contain healthcare costs by creating incentives for physicians and enabling hospitals to collaborate in improving care efficiency.

How does pay for performance (P4P) improve quality care?

Pay-for-performance (P4P) entails a reimbursement model that provides financial incentives to healthcare providers for reporting improvements in performance measures of efficiency, quality, and outcomes. Berkovich & Sitapati (2019) argue that P4P programs can impose financial penalties for the failure to meet performance thresholds and targets.

This approach can improve care quality by providing financial incentives to healthcare providers, enhancing adherence to best practices, and encouraging healthcare professionals to address the threat to patient safety, including avoidable readmissions, falls, and medication errors.

A Brief Discussion of Value-based Purchasing Program

Value-based purchasing program is a reimbursement model that links provider payments to improved performance by healthcare organizations and professionals. In this sense, the major focus of value-based purchasing is to hold care providers accountable for care quality and costs to reduce inappropriate care services and reward best-performing providers.

According to the Centers for Medicare and Medicaid Services (2021), value-based purchasing (VBP) rewards acute care hospitals by incentivizing processes for the quality of care provided to patients in hospital settings. Therefore, this program seeks to improve care for hospitalized patients and enhance patients’ experiences.

How do value-based purchasing (VBP) programs affect reimbursement to hospitals?

Value-based purchasing programs can positively or negatively affect reimbursement to hospitals depending on healthcare organizations’ determination and ability to provide quality care. Firstly, VBP programs incentivize hospitals to improve patient experiences, satisfaction, and care quality.

Also, these initiatives recognize hospitals that provide high-quality care at a reasonable cost to Medicare (Centers for Medicare and Medicaid Services, 2021). Therefore, healthcare institutions receive increased reimbursements for delivered care.

Equally, VBP programs can reduce incentives for institutions that fail to provide quality and cost-effective care. As a result, it operates as a profound strategy for motivating healthcare organizations to achieve various dimensions of care quality, including efficiency, cost-effectiveness, timeliness, and patient-centeredness.

Who benefits the most from value-based reimbursement and why?

Healthcare institutions and professionals are responsible for providing quality care and reducing per capita costs. As a result, they benefit from value-based reimbursement programs after improving the quality of care and enhancing patients’ experiences.

It is essential to note that healthcare institutions can improve care quality and patient experiences by eliminating and reducing adverse events, implementing evidence-based care strategies, increasing care transparency, and involving patients in care delivery processes (Centers for Medicare and Medicaid Services, 2021). Therefore, patients are also beneficiaries of value-based purchasing programs because they enjoy high-quality, cost-effective services.

How does the VBP program measure hospital performance?

The VBP program measures hospital performance by relying on various aspects, including mortality and complications, patient safety, patient experience, efficiency, cost reduction, and hospital-acquired infections (HAIs). The Centers for Medicare and Medicaid Services (2021) argues that each hospital earns 2 scores on each of these performance measures (one for achievement and one for improvement).

Further, the program applies the 50th percentile for primary care thresholds to measure hospital performance. As a result, hospitals with the highest Improvement scores receive reimbursement in form of incentives.

References

Alotaibi, Y., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal, 38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631

Berkovich, B., & Sitapati, A. M. (2019). Applied population health: Delivering value-based care with actionable registries. Productivity Press.

Centers for Medicare & Medicaid Services. (2021, February 18). Hospital value-based purchasing. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HVBP/Hospital-Value-Based-Purchasing

Falkson, S. R., & Srinivasan, V. N. (2022). Health maintenance organization. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554454/#

Genovese, U., Del Sordo, S., Pravettoni, G., Akulin, I. M., Zoja, R., & Casali, M. (2017). A new paradigm on health care accountability to improve the quality of the system: Four parameters to achieve individual and collective accountability. Journal of Global Health, 7(1), 010301. https://doi.org/10.7189/jogh.07.010301

Gossman, W., de la Torre, J. I., & Varacallo, M. (2022). Accountable Care Organization (ACO). StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448136/

Hardin, L., Kilian, A., & Murphy, E. (2017). Bundled payments for care improvement. JONA: The Journal of Nursing Administration, 47(6), 313–319. https://doi.org/10.1097/nna.0000000000000492

Assignment Description: Accountability in Healthcare

This assignment will be at least 1500 words. Address each bulleted item (topic) in detail including the questions that follow each bullet. There should be three (3) sections in your paper; one for each bullet below. Separate each section in your paper with a clear brief heading that allows your professor to know which bullet you are addressing in that section of your paper. Include a Conclusion section that summarizes all topics.

This week you will reflect upon accountability in healthcare and address the following questions:

Briefly define an Accountable Care Organization (ACO) and how it impacts health care providers:
How do ACOs differ from the health maintenance organizations (HMOs) of earlier years
What role does health information technology (HIT) play in the newer models of care?
What is the benefit of hospitals partnering with primary care providers?
How does bundling payments contain healthcare costs?
How does pay for performance (P4P) improve quality care?
Briefly discuss the value-based purchasing program?
How do value-based purchasing (VBP) programs affect reimbursement to hospitals?
Who benefits the most from value-based reimbursement and why?
How does the VBP program measure hospital performance?

Start by reading and following these instructions:

Study the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.

Consider the discussion and the any insights you gained from it.

Review the Assignment Rubric and the specifications below to ensure that your response aligns with all assignment expectations.

Create your Assignment submission and be sure to cite your sources, use APA style as required, check your spelling, and review the rubric.

The following specifications are required for this assignment:

Length: 1500-2000 words; answers must thoroughly address the questions in a clear, concise manner
Structure: Include a title page and reference page in APA format. These do not count towards the minimal word amount for this assignment. Your essay must include an introduction and a conclusion.
References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two (2) scholarly sources are required for this assignment.

Format: Save your assignment as a Microsoft Word document (.doc or .docx).

Filename: Name your saved file according to your first initial, last name, and the module number (for example, Hall Module 1.docx”)