Answer for HCA 615 What are the pros and cons of different methods for improving the delivery of care within health care organizations? Module 5 DQ 2

 

Different approaches have been used to improve the delivery systems in health care organizations. Bundled payment programs are among the approaches of reimbursement of health services delivered based on the expected costs of clinical care. The approach works on a framework of shared risks and, therefore, patients receive quality care at relatively low costs. The method has attracted commercial payers who provide an avenue for fee-for-service reimbursement based on care delivered to patients (Kinney, 2015). However, bundled payment has a limitation of operational barriers related to the management of cash flows and developing a budget that consistently conforms to the episode-based payments. It is also challenging to keep a track of enrolment of the commercial payers to the bundled payment model.

Health care organizations can also use quality reporting programs as methods to improve care provided to patients. In this context, health providers receive incentives for quality measures delivered to clients. The method ensures that professionals provide higher-quality care to patients at lower costs (Hammer, Vice, & Manchikanti, 2016). Conversely, the effectiveness of quality reporting programs is challenged by misuse of cost measures information where professionals may avail false report about the health status of patients for them to receive value-based payments.  Besides, the method has a limitation of low confidentiality as the information about the patient may be shared to the third party payers without the consent of the client.

Health care organizations can use methods that incorporate Accountable Care Organizations (ACOs) programs to ensure that patients receive high-quality care (Kinney, 2015). However, inconsistencies of the third-party payers or delays in remittance by the federal government for patients in Medicaid programs can compromise the quality of care provided to patients using this method.
References
Hammer, K. M., is Vice, H., & Manchikanti, L. (2016). Physician Quality Reporting System (PQRS) for interventional pain management practices: Challenges and opportunities. Pain Physician, 19(E15), E15-E32.

Kinney, E. D. (2015). The affordable care act and medicare in comparative context. New York, NY: Cambridge University Press.
Sample Answer 2