Responding to post NR-533
Write a response essay to the below classmate discussion post.
Classmate Discussion Post:
When it comes to the case of 69yo Jim – the hospital might benefit more from volume-reimbursement, as with this, “paid by Medicare or other commercial payers, based on quantity of services provided” (Martin, 2017), because as stated in the scenario, Jim had multiple diagnostic tests completed prior to him having an emergency appendectomy. Value-based reimbursement could potentially make the hospital less money, as this type of reimbursement is based on performance, and one of the key factors looked at with this is, length of stay, as well as re-admission rated. Jim was discharged after his outpatient appendectomy, however returned only 2 weeks later with a post-op infection, to where he had to get admitted for almost a week for treatment. The change of reimbursement for this scenario if value-based reimbursement is used be the hospital is slim due to the post-op complication which lead to re-admission.
When it comes to Triple-Aim performance (TAP), we’re talking about the “achievement of high performance on clinical quality, patient experience, and technical efficiency” (Tucker et al., 2019). This is difficult to measure because it is confounded not only by multi-dimensionality, but also by the difficulty of measuring each dimension separately since each is composed of multiple proxy variables. The three goals of TAP are of central concern to patients, health care organizations, clinicians, and payers. First, a hospital patient’s experience is important on its own merit, and it is also in the spotlight of regulators. Secondly, good clinical outcomes improve quality of life for patients. U.S. Centers for Medicaid and Medicare Services (CMS) provides financial incentives for excellent performance on clinical quality measures, such as process of care, mortality, and readmissions, and third, technical efficiency is crucial because health care accounts for a substantial and growing percentage of the US gross domestic product. When talking about Jim and his hospital visit, and re-admission, both volume-based and value-based reimbursement are impacted due to his post-surgery outcome.
