Create a 2-3 page memorandum (excluding Reference page) for Vila
Health stakeholders that compares older and newer reimbursement models
and informs stakeholders about how each model would impact their
organization.
Instructions:
Note: This assessment uses the following media as the
context for developing the reimbursement model memo. Review this media
before you submit your assessment.
Vila Health: Investigating a Readmission.
Basic understanding of the reimbursement system requires one
to appreciate the size and scope of the system, the complexities
associated with the system, and the various subsystems and payment rules
associated with health care reimbursement and finance. As a dominant
player in the health care sector, the U.S. federal government is the
largest single payer for health care services. As a result of its size
and dominance within the system, any changes made by the federal
government regarding its reimbursement of health services profoundly
affects those who are rendering the care, including providers, other
payers, and the health system overall. In addition to
government-sponsored health insurance, various other forms of health
coverage, generally tied to employment as a benefit, were introduced in
the United States to help offset the expenses associated with the
treatment of illness and injury.
In an effort to address concerns within the U.S. health
system regarding cost, access, and quality, Congress passed the Patient
Protection and Affordable Care Act (PPACA or ACA) in 2010, with
President Barack Obama signing it into law. Components of the PPACA
included making health insurance coverage affordable, expanding Medicaid
coverage, and improving quality while controlling costs. To this end,
the ACA required the Centers for Medicare & Medicaid (CMS) to
promote the concept of the accountable care organization (ACO) through a
shared savings plan driven by a triple-aim approach. In addition to the
ACO, the ACA required CMS to implement value-based purchasing programs
that would reward hospitals for the quality of care they provided to
enrollees.
As the recipient of the largest share of Medicare funds, the
new value-based purchasing approach measures hospital performance using
four domains:
Clinical care.
Safety.
Efficiency and cost reduction.
Patient experience of care (Casto & Forrestal, 2019, p. 274).
Each measure scores the hospital performance achievement as well as their performance improvement.
As a health care sector employee, understanding the complex
U.S. health care reimbursement system allows one to serve as a reference
to internal and external stakeholders, family members, and
organizational departments whose needs often require a working knowledge
of how the system is financed.
In this assessment, you will demonstrate your understanding
of traditional and emerging health care reimbursement models by
composing a memo that outlines the characteristics and differences
between reimbursement models. This memo targets relevant stakeholders
from the Vila Health media simulation based in St. Anthony Medical
Center.
Reference
Casto, A. B. (2019). Principles of healthcare reimbursement (6th ed.). AHIMA Press.
INSTRUCTIONS:
You will use Vila Health: Investigating a Readmission as the context to address parts of this assessment.
Several of Vila Health’s stakeholders are seeking
clarification regarding new reimbursement models they have been hearing
about recently. For this assessment, prepare a 2–3 page memorandum
outlining the differences between the new reimbursement models and
prior, traditional models for stakeholders.
Use the Reimbursement Model Memo Template [DOCX]
Download Reimbursement Model Memo Template [DOCX]
to help structure each section of your memo. Support your assertions in
the memo with at least three academic sources. This may require you to
do additional independent research.
In your memo, address each of the following scoring guide criteria:
Describe traditional payment models in health care.
“Describe” means to give an account in words of
(someone or something), including all the relevant characteristics,
qualities, or events.
Identify the traditional payment models.
What are the key characteristics of these reimbursement models?
How was quality monitored under these models?
This part should be at least one paragraph long, but probably no more than half a page.
Describe current trends in health care payment models.
Identify the current trends in health care payment models.
What are the key characteristics of these reimbursement models?
How is quality monitored under these models?
This part should be at least one paragraph long, but probably no more than half a page.
Compare and contrast how quality outcomes are rewarded under traditional and current payment models in health care.
Develop a concise comparison of the key
similarities and differences of the reimbursement process between
traditional and current models.
This part should likely be between a half and one page long.
Describe quality concerns affecting reimbursement given a specific patient scenario.
Specifically address the recent problematic patient case from the Vila Health: Investigating a Readmission scenario.
Briefly discuss how the care provided would be
reimbursed under prior models versus reimbursement under newer models,
based on assertions you made in the previous section of your memo.
Also, identify quality issues that will likely impact the organization’s reimbursement under new payment models.
This part should be at least one paragraph long, but probably no more than half a page.
Adhere to the rules of grammar, usage, and mechanics.
“Grammar” refers to the basic rules for how
sentences are constructed and how words combine to make sentences (for
example, word order, case, and tense).
“Usage” refers to correct word choice and phrasing, particularly with regard to the meanings of words and phrases.
“Mechanics” refers to correct use of capitalization, punctuation, and spelling.
Apply APA formatting to in-text citations and references.
ADDITIONAL REQUIREMENTS:
Structure: Structure your submission like a memo, with an additional, APA-style References page. Use the Reimbursement Model Memo Template [DOCX] provided.
Length: 2–3 pages, excluding a References page.
References: Cite at least three current scholarly or professional resources.
Your textbook can be one of the three.
Format: Use APA style for references and citations only. Refer to:
APA Style Paper Tutorial [DOCX].
Evidence and APA.
Font: Times New Roman, 12 point, double-spaced.
