Alternate Payment Systems

Question 1

Triple Aim for Health Care system

Answer 1

1. Better health outcomes
2. Improved Patient Experience
3. Cost Containment

Question 2

Current US payment model

Answer 2

a maze of payment systems- governmental and private

outpatient systems generally reward volume of care
volume of care has not been shown to be better care in fact shown to be the opposite

Question 3

Dis-integrated silos of care are typically and usually focused on _____ instead of longitudinal patient centerd care

Answer 3

episodes

Question 4

providers often deliver care based on _____

Answer 4

incentives

Question 5

Current US payment mode is focused on

Answer 5

episodic care

Question 6

CMS: shifting the incentives payment from _____ to _____

Answer 6

volume to values

Question 7

Why is a shift needed in the US healthcare system

Answer 7

rising health care costs

Question 8

What part of medicare is expected to rise the most?

Answer 8

Par B- if physicians are getting paid for medicare then they aren’t going to take the insurance- further creating disparities

Question 9

What was happening in SNFS with PT

Answer 9

PT were ranking patient high on the complexity scale therefore they need to change the RUG system

Question 10

observation stay

Answer 10

billed as an outpatient treatment
need to warn patients before seeing them because they will be billed by part b fee for service not as a part of their hospital stay

Question 11

Why is the shift needed in terms of aging populations

Answer 11

people will be aging using more medicare

Question 12

Fragmented care is _____ and increases patient ____

Answer 12

inefficient and expensive and increases patient safety risk

Question 13

What is systems thinking?

Answer 13

seek to understand the big picture
observe how elements within a system change over time, generating patterns and trends
recognize that a system structure determines behavior

Question 14

What are the major reasons for a shift in the payment method

Answer 14

1. aging population
2. cost
   3 Use
   4 fragmented care is expensive and inefficient

Question 15

Value is defined as

Answer 15

health outcomes/ dollars spent

Question 16

Value based care

Answer 16

a healthcare delivery model that providers are paid based on patient health outcomes
providers are rewarded for helping improve patient health, reduce effects and incidence of chronic disease

Question 17

Value based care
_____ cost and better outcomes
_____ patient satisfaction and better efficient care

Answer 17

lowers costs and betters outcomes
increases patient satisfaction and better efficient care

Question 18

Role of affordable care act: CMMI

Answer 18

fee for service payment model needs reform because it rewards volume not value

Question 19

ACA granted CMMI authority to do what

Answer 19

1. lower spending without reducing the quality of care
2. improve the quality of care without increasing spending

Question 20

Medical Homes

Answer 20

team based model of patient care
Rely heavily on PCP/team- comprehensive team makes decisions

Focuses on coordination of the majority of health, illness and wellness care for medicare beneficiaries

Question 21

Accountable Care Organizations

Answer 21

hospital, doctors and other providers group together and agree to share collective accountability for the quality and cost of care delivered to the patients in their ACO

payments to ACO incorporate financial incentives in the form of shared savings or loses for performance on identified spending and quality metrics

Question 22

Bundled Payments

Answer 22

focus on discrete episodes of care
EX: joint replacements
overall budget for services provided to a patient receiving a course of treatment for a given clinical condition over a defined period of time

provide incentives for providers to come in under budge for episodes of care

Question 23

Bundled payment equality risk

Answer 23

may penalize participants serving medically or socially high risk patients

Question 24

risk for bundled payment may work for wealthy hospitals but not ____

Answer 24

unweathly hospitals

Question 25

medicare bundled payment for comprehensive joint replacement general model

Answer 25

hospital which the surgery takes place is financially accountable for quality and cost from date of surgery through 90 days

Question 26

how does payment work for the medicare bundled payment plan

Answer 26

if the hospital spends alot of money they have a penalty if they dont they get a bonus

uchealth began to partner with HH and post acute to get reconciliation payment

Question 27

To make the medicare bundled payment you must meet the 3 quality measures

Answer 27

1. low 30 day hospital re-hospitalization rate
2. low rates of complications within 90 days
3. hospital consumer assessment of healthcare- high customer satisfaction rate

Question 28

What is no longer required with the medicare bundled payment

Answer 28

1. 3 night hospital stay if the SNF has at least 3 out of 5 star rating on nursing home compare website
2. homebound requirement for home health
3. telehealth restrictions

Question 29

medical homes are best for what type of patient

Answer 29

long term medical
childrens hospital
long term social support

Question 30

accountable care organizations are best for what type of patient

Answer 30

not for long term care
short term major episodes

Question 31

bundled payments

Answer 31

more coordinated like joint replacement, bipass surgery
hospital coordinates the major acute episode cost