Home Care Flashcards
In assisted living centers - the residents ____ their health care providers
have their choice
In SNFs or NH - the residents ___ their health care providers
do not choose - the facility decides on the provider
DRGs
Diagnostically related groups
Hospital gets x amount of dollar for x diagnosis no matter the time
BBA
Balanced budget act of 1997
This is when caps started for therapy
PPS
Prospective Payment System
Paying based on their outcomes and quality of care
Goal of accountable care organizations (ACOs)
The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors
When an ACO succeeds in both delivering high quality care and spending health dollars more wisely, it will
Share in the savings it achieves for the medicare program
Qualification criteria for home health - based on CMS
1 Homebound status
2 Services provided under POC established
3 Aliving facility if institution is not primarily engaged in providing diagnostic or rehab services
4 Safety, food, toileting, fire
Reimbursement issues
30 day reassessment to show progress and why need PT (specialized care) and how it is functional for them
Nurse needs to complete OASIS prior to starting
Value based purchasing
CMS views implementation of a home health VBP program as an important step in revamping hoe medicare pays for health care services
Moving more towards patient focused care instead of volume of services provided
VBP program is based on what
How many patients are re-admitted to hospital after you see them
Rating based on these type of things (bell curve) - get reimbursed more for higher rating
A lo based on OASIS too and change in it over time
Purpose of VBP
Using financial incentives to reward quality and improvement in health care
Aim to hold providers accountable for quality of care they provide
Bundled payments - traditionally medicare makes separate payments to providers for each individual service they furnish to beneficiaries for a single illness - this approach can result in
fragmented care with minimal coordination across providers and health care settings
Bundled payments - payment rewards what
the quantity of services offered by providers rather than the quality of care furnished
Bundled payments - research has shown that bundled payments can
align incentives for providers, allowing them to work closely together across all specialties and settings
Bundled payments - model 1 - the episode of care is defined as
the inpatient stay in the acute care hospital - medicare pays the hospital a discounted amount based on the payment rates established under the inpatient prospective payment system
Medicare continues to pay physicians separately for their services under the medicare physician fee schedule
Bundled payments - model 2 and model 3 involve what
a retrospective bundled payment arrangement where actual expenditures are reconciled against a target price for an episode of care
Bundled payments - in model 2 the episode includes
the inpatient stay in an acute care hospital plus the post acute care and all related services up to 90 days after hospital discharge
Bundled payments - in model 3 the episode of care is triggered by
an acute care hospital stay but begins at initiation of post acute care services with a SNF, IPT rehab, LTAC, or HHA
Bundled payment - model 4 - CMS makes what payment
a single prospectively determined bundled payment to the hospital that encompasses all services during the episode of care - lasts the entire hospital stay
Bundled payment - model 4 - physicians and other practitioners sumbit ___ to medicare and are paid ___
no pay claims and are paid by the hospital out of the bundled payment
OASIS
Outcome and assessment information set
