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4-1 Discussion Quadruple Aim Bulls-Eye
Healthcare Delivery Systems (HCM340)
Southern New Hampshire University
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4-1 Discussion: Quadruple Aim Bull's-Eye
Hi everyone!
The initiatives I was assigned were the Hospital Value-Based Purchasing Program (VBP) and Inpatient Prospective Payment System (IPPS). The Hospital VBP Program incentivizes hospitals that provide higher levels of quality care to low-income patients who utilize Medicare and Medicaid programs. Before the program was established in 2010 under The Affordable Care Act, hospitals treated patients with government-based insurance as numbers and ushered them in and out as fast as possible to make more money. They moved the patients through care quickly because Medicare and Medicaid have very low allowed payments compared to private insurance companies. The Inpatient Prospective Payment System measures the quality of inpatient care through the Hospital Inpatient Quality Reporting Program on healthcare-associated infections, patient care experience, complications, mortality, patient safety, healthcare efficiency, and cost reduction. Under IPPS, hospitals that have high numbers of low-income patients receive additional payments, so they do not decline care to those of low socioeconomic status because of not receiving higher payments from private insurers, which is called the disproportionate share hospital (DSH). Lastly, these programs reward teaching hospitals that are approved for add-on pay under IPPS. All of these initiatives aim at improving patient care and reducing socioeconomic gaps in healthcare by pushing providers to better inpatient care for all economic backgrounds affording future providers, like myself, the opportunity to contribute superior medical care to everyone.
Initial Post:
In your post, explain how the initiative you were assigned by your instructor addresses a gap in healthcare. Use the Quadruple Aim framework as a benchmark for discussing how the initiative improves care, and explain how the initiative applies to your current or future career in healthcare.
Topic: Hospital Value-Based Purchasing Program (VBP) and Inpatient Prospective Payment System (IPPS)
Use the Triple Aim framework to discuss how this initiative improves care. There are six different topics (you will be assigned only ONE of the six). To make this more interesting, try to comment on a topic other than your own (for your follow-up posts).
Hospital Value Based Purchasing (VBP) aims to incentivize inpatient providers to delivery high value, as opposed to high volume, health care. The formal mandate of hospitals to provide high value health care through financial incentives marks an important change in Medicare and Medicaid policy.
The Hospital Value-Based Purchasing (VBP) Program
What is the Hospital Value-Based Purchasing (VBP) Program?
The Hospital VBP Program rewards acute care hospitals with incentive payments for the quality of care provided in the inpatient hospital setting. This program adjusts payments to hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of care they deliver.
Why is the Hospital VBP Program important?
The Hospital VBP Program is designed to make:
The quality of care better for hospital patients. Hospital stays a better experience for patients.
The Hospital VBP Program encourages hospitals to improve the quality, efficiency, patient experience and safety of care that Medicare beneficiaries receive during acute care inpatient stays by:
Eliminating or reducing adverse events (healthcare errors resulting in patient harm). Adopting evidence-based care standards and protocols in order to obtain the best outcomes for Medicare patients. Incentivizing hospitals to improve patient experience.
Increasing the transparency of care quality for consumers, clinicians, and others. Recognizing hospitals that provide high-quality care at a lower cost to Medicare.
How does the program work?
We reward hospitals based on the quality of care provided to Medicare patients, not just the quantity of services provided.
The program:
Withholds participating hospitals’ Medicare payments by a percentage specified by law (2%). Uses the estimated total amount of those reductions to fund value-based incentive payments to hospitals based on their performance in the program. Applies the net result of the reduction and the incentive as a claim-by-claim adjustment factor to the base operating Medicare severity diagnosis-related group (MS-DRG) payment amount for Medicare fee-for-service claims in the fiscal year associated with the performance period.
What measures are used in the Hospital VBP Program?
Hospitals are scored on measures such as:
Mortality and complications Healthcare-associated infections
Patient safety Patient experience
Efficiency and cost reduction
Each hospital may earn 2 scores on each measure—one for achievement and one for improvement. The final score awarded to a hospital for each measure is the higher of these 2 scores. We adjust a part of hospitals’ Medicare payments based on a total performance score that reflects, on a measure-by- measure basis:
How well they perform compared to all hospitals, or
The Quadruple Aim adds a fourth policy implication, for example, addressing the needs of the healthcare provider.
Improved Clinical Experience
Each of the above-mentioned dimensions is critical in optimizing the health system performance, but one crucial aspect is missing — the care providers themselves. As value-based care becomes more prevalent, the quality of care that is provided becomes essential, and it all starts with the provider. The pressure that is put on caregivers is immense, leading to unwanted outcomes that can negatively affect the quality of care provided.
According to Medscape’s annual Physician Lifestyle Report, 42% of physician respondents reported burnout. Also, a HealthLeaders article highlighted the correlation between decreased staff engagement or burnout and lower patient satisfaction, reduced health outcomes, and higher costs — which goes directly against the Triple Aim.
In order to combat this, an improved clinical experience should be included in the Triple Aim, updating it to the Quadruple Aim.
The Quadruple Aim is similar to a compass in that it guides the direction that the health system — including both patients and providers — needs to go in. The change won’t happen overnight, nor will improving the health system performance. Rather, continuously updating and optimizing will have a compounding factor that will ultimately lead to a healthier and happier population.
In 2007, the Institute for Healthcare Improvement (IHI) developed a framework for helping healthcare systems optimize performance using a variety of metrics. Since the framework uses a "three-pronged approach," the IHI called it the Triple Aim. 1
The Triple Aim's three areas of focus are:
Improving patient experience
Reducing the per capita costs of health care
Improving the health of populations overall (Better Outcomes)
Achieving the Triple Aim will be crucial to the success of healthcare organizations that are moving toward value-based payment systems. The Triple Aim also encourages healthcare leaders to use the strategies to improve the health of their communities 2 beyond the hospitals and clinics that make up the healthcare system.
While the Triple Aim has three components, they are not necessarily steps. Healthcare organizations should pursue all three prongs of the Triple Aim at the same time.
There are, however, several steps healthcare organizations can take leading up to implementation that will help make the transition go more smoothly:
Figure out the unique needs of the community and identify at-risk populations
Establish organization and system-specific goals Develop a way to measure, track, and demonstrate progress
Improving Patient Experience
One of the primary goals of the Triple Aim is to improve the experience patients have when they are interacting with the healthcare system. In order to do this effectively and at the population level, healthcare systems need to assess the overall health of the communities they serve, identify any existing concerns or areas of risk, and assess overall mortality. 3
Additionally, there have been several initiatives over the last decade aimed at helping patients navigate the healthcare system more easily. This has included steps to improve communication between providers.
Electronic health records (EHR), Accountable Care Organizations (ACOs), and Managed Care Organizations (MCOs), Shared Decision Making 4 , and patient-centered care coordination teams are just a few examples of the changes being implemented in healthcare systems throughout the United States.
Healthcare organizations can track the impact of these changes through patient satisfaction surveys and established quality improvement measures.
Reducing Cost
The United States has the most expensive healthcare system in the world, 5 making up 17% of the gross domestic product (GDP). By 2020, that number is expected to reach 20%. While the cost of healthcare services is rising, the quality of those services is not.
4-1 Discussion Quadruple Aim Bulls-Eye
Course: Healthcare Delivery Systems (HCM340)
University: Southern New Hampshire University
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