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Value-based care is a healthcare delivery model in which providers, including hospitals and physicians, are paid on the basis of patient health outcomes

Value-based care is a healthcare delivery model in which providers, including hospitals and physicians, are paid on the basis of patient health outcomes. Value-based care includes three key goals: improved population health, increased patient satisfaction, and reduced cost. Each of these goals affects the stakeholders differently. For example, value-based care aims to lower costs across the board, which would result in the insurance companies having to pay lower reimbursements. If insurance companies incur lower costs, they are less likely to raise premiums and deductibles.

Before you begin working on the assignment, review the module learning resources. These resources will help you with additional guidance to complete this assignment.

In this assignment, you will choose two acute care hospitals in your state. Do not select critical access hospitals for comparative analysis. Because critical access hospitals are exempted from sharing information with the Centers for Medicare and Medicaid Services (CMS), you may not get enough information about these hospitals for comparison. You will compare the selected hospitals on the basis of various quality metrics defined by the CMS. Then, you will conduct a comparative analysis of both the hospitals using specific quality metrics: patient survey ratings, complications, and death rates and unplanned hospital visits. This analysis will help you understand how value-based care and quality metrics in healthcare impact stakeholders. Also, this assignment will help you understand how stakeholders influence the decision-making process in healthcare.

Prompt

To complete this assignment, you will submit an analysis report that includes the comparative analysis of two chosen hospitals. In this assignment, you will choose two acute care hospitals from your state and conduct a comparative analysis. Use module resources to understand how to conduct the comparative analysis on selected hospitals. You will use quality metrics and national benchmarks defined by the CMS. You will then create an analysis report that includes the comparative table and a summary of your analysis to demonstrate your findings.

You must cite at least three sources to support your claims. For additional help with completing this assignment, refer to the Shapiro Library Guide: Nursing – Graduate item in the Start Here module. You may also use the Online Writing Center, located in the Academic Support module.

Specifically, you must address the following rubric criteria:

  1. Selection of Hospitals: Justify your selection of two acute care hospitals for comparative analysis.
  2. Analysis of Patient Survey Ratings: Analyze the comparative performance of selected hospitals pertaining to patient survey ratings quality metrics. Consider the following questions in your response:
    1. How does the patient survey quality metric impact the government and private insurance reimbursement?
    2. Why is the patient survey one of the essential quality metrics for value-based care?
    3. Did underserved/vulnerable populations participate in the patient survey? Why is their inclusion essential?
  3. Analysis of Complication and Death Rates: Analyze the comparative performance of selected hospitals pertaining to complication and death rate quality metrics. Consider the following questions in your response:
    1. How do complication and death rate quality metrics impact the government and private insurance reimbursement?
    2. How do the complication and death rates impact value-based care?
  4. Analysis of Unplanned Hospital Visit Ratings: Analyze the comparative performance of selected hospitals pertaining to the unplanned hospital visits quality metric. Consider the following questions in your response:
    1. How does the unplanned hospital visits quality metric impact the government and private insurance reimbursement?
    2. What does the unplanned hospital visits quality metric indicate about value-based care?
  5. Summary of Analysis: Summarize your findings from your comparative analysis of the two hospitals. Include the national benchmarks for the quality metrics you have used for your analyses. Consider the following questions in your response:
    1. How do value-based care quality metrics impact healthcare stakeholders such as insurance providers, hospitals, and patients?
    2. Do the mentioned three quality metrics or any other quality metrics defined by the CMS include underserved/vulnerable populations’ challenges related to value-based care?

What to Submit

Your submission should be a 2- to 3-page Word document. You must also include an APA-style title page. Use 12-point Times New Roman font, double spacing, and 1-inch margins. Sources should be cited according to APA style

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Training tailored to clinician role Training the patients and providers

 Clinician involvement in EHR design: Implementation testing (Pre and post)

Is the reality of the true cost of an EMR sinking in now that systems are live?

How do clinicians, your colleagues and patients feel about HER and how do you feel?

Factors that facilitate adaptation

Training tailored to clinician role

Training the patients and providers

concerns about communication about upgrades.

involvement in EHR design, including physicians in EHR training

How do we ensure Privacy and security?

How do you protect patient data in a mobile world?

What organizational policies have been established to ensure patient data is secured?

The functionalities that the EMR serves to the hospital and how have these functionalities changed or evolved over the duration that they have had this EMR.

What features in EHR do you like?

The advantages of using the EMR system

Impact of changes

Impact of EHR use on patient care

The challenges of using the EMR system

The perception of the EMR among the clinicians, healthcare workers and patients.

The impact of attitude on an individual’s response to change can be significant.

A positive, accepting attitude toward change to Improve quality, safety, and efficiency

Who accesses the system?

Physicians sometimes focus more time on the electronic health record than on the patient. What will be done to make EHRs less time consuming?

How do we address and resolve the limited availability of integration experts that has resulted from the increasing integration complexities?

What type of data goes into EHR?

How do we map different terminologies within devices, hospitals and across the industry so EHR integration can be completed more efficiently and effectively?

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Medicare claims that some large healthcare providers have falsified claims and/or cost reports

Q1:  Medicare claims that some large healthcare providers have falsified claims and/or cost reports. Why, in your opinion do companies tend to overbill services and/or falsify cost reports?  Think of multiple reasons, not just one reason. 

Q2: Discuss fraud and abuse.  Pick two of these initiatives and describe what you know about them or if you’ve had any experience with them.  Why is fraud and abuse important to the federal government in 2012? 

Please provide detailed information and no plagiarism. 

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Australians can purchase flu vaccinations from many different immunisation providers such as pharmacies, doctors’ practices and community health centres

Assessment Task 3
Answer any FOUR of the following questions. Each question is worth a total of 12.5 marks. If more than four questions are answered, marks will be awarded for the first four answers only.
QUESTION 1
At the beginning of the flu season, Australians can purchase flu vaccinations from many different immunisation providers such as pharmacies, doctors’ practices and community health centres. A recent scientific study showed that getting a flu jab reduces both the chance of getting COVID-19 and COVID-19 symptoms. This welcome news has been widely reported in the newspapers. Examine the likely consequences in one or two related markets of your choice.
QUESTION 2
Governments generally want people to get immunised against the flu and other diseases such as COVID-19. Nonetheless many people refuse to take the vaccination jab, because they overestimate the likelihood of side effects, because they are complacent about getting infected. They also might not care or understand that their immunity protects others. Use the theories of market failure and government intervention to analyse the motives of government, the anti-vax phenomenon and their consequences. What, if anything should government do to make more people get vaccinated? What would be the problems with such interventions?
QUESTION 3
When COVID-19 stated spreading across the world, the race was on to develop vaccines as quickly as possible. Such research & development has a high fixed cost and can only be undertaken in industries with high market concentration where firms have significant monopoly power, like the pharmaceutical industry. Examine this industry using the theory and models of industry structure. Should government be worried about any aspect of how an industry with this market structure will perform?
QUESTION 4
Pfizer is one of the world’s largest pharmaceutical companies. Developing its COVID-19 vaccine is a costly, uncertain and complex process. This company would need to consider which parts of the vertical chain to outsource and which to conduct inhouse. Using the theory of the optimal boundary of the firm, discuss Pfizer’s make-or-buy decision for developing and producing its COVID vaccine. What stages of the vertical chain should Pfizer consider conducting inhouse, and which should be outsourced? Provide reasons for your findings.
QUESTION 5
Consider the following hypothetical case. Only Pfizer and a competitor, Astra-Zeneca, have the ability to develop a COVID-19 vaccine. Both have access to the same two promising vaccine technologies, but each company must choose one to invest in. While each firm could develop a vaccine on its own, the problem is that the fixed cost of production and risk are very high. They are therefore considering coordinating their actions through a strategic alliance where they join forces and share cost and revenue equally. Analyse the interaction between the two firms using game theory. Present a payoff matrix to model the situation and analyse it for Nash equilibrium. What can either of these firms do to make their best, most-preferred outcome more likely?

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U.S. government reimbursement policies for healthcare providers impact the use of telemedicine in your state

How does U.S. government reimbursement policies for healthcare providers impact the use of telemedicine in your state (CALIFORNIA)? 

Expectations

Initial Post:

  • Due: Friday, November 13
  • Length: A minimum of 250 words, not including references
  • Citations: At least 2 scholarly reference in APA 7th ed from within the last 5 years