Bundle Payment Analysis

Improved Essays
Protecting Medicare Beneficiary’s for Bundle Payment
With bundled payments Medicare beneficiaries are offered a choice of what level of care they will receive regardless of physician orders. Hospitals offer a list of all participating providers within the patient’s service area, so that they can determine which provider they will use for their health care services. The hospital encourages the patients to seek better community service line areas out of the list providers that they have collaborated services to potentially enhance monetary gain. In order for the organization to achieve this goal educating patients who the higher quality providers are will be essential. To achieve these outcomes, an important part of the nurse executive’s
…show more content…
It will be important to generate reports that are necessary to classify at risk patients and compare organization’s performance to benchmarks. Reporting through information sharing through the electronic health record (EHR) and quality monitoring will be vital to ensure preferred provider practices and outcomes are in place for bundled payment participation. The key to an organization’s success in bundle implementation is to invest in a robust technology solutions that outline resource capabilities for storing, managing, and analyzing of both financial and clinical data aspects to accommodate best-practice, while reducing costs and improving operational …show more content…
The professional domain provides the nurse executive with the ability to create an environment favorable to advocating for optimal health care in the community, while representing the viewpoint of patients and families in the patients care (AONE, 2011). The competencies provide the nurse executive with skills essential for being able to comprehend how to analyze a budget’s performance through the business skills domain, which permits the leader to better manage financial resources adequately. In addition, knowledge of technology platforms will be essential to the effectiveness of hospital operations. Nurse executives that possess excellent leadership and business skills, along with understanding the health care delivery system will have gained insight of future innovations needed to provide excellent quality of care while achieving favorable organizational

Related Documents

  • Great Essays

    These varied experiences are well suited for directing operations of patient care services and directing care related to risk, quality and safety. Within each of these roles, as defined by the framework outlined by the ANA (2009) scopes and standards of practice include my strengths in the nursing process, the culture of quality and safety. The practice environment qualifications I possess include regulatory, legal and risk proficiency. These areas are examples of practice where my skills are refined and my level of expertise is sought by others in my…

    • 1278 Words
    • 6 Pages
    Great Essays
  • Decent Essays

    In 2009, they launched the Brookings–Dartmouth ACO pilot program, which involved five diverse provider groups who agreed to take responsibility for overall quality and costs of care for their patients, had a committed payer partner, and had sufficient patient population to support comprehensive care coordination and performance measurement. In addition to providing technical consultation and support, Brookings–Dartmouth conducted case study evaluations of four of the organizations to inform providers, payers, and policy makers about the process of ACO formation,2 and developed a Learning Network of emerging ACOs and supporting organizations and companies.…

    • 92 Words
    • 1 Pages
    Decent Essays
  • Decent Essays

    MSN Essential: Organization and Systems Leadership The second Essential deals mainly with organizational and systems leadership in order to provide high-quality care that is not only safe but also effective (AANC, 2011). Leadership skills are part of a core foundation for Nurse Practitioners and in order for them to be effective must establish working relationships in collaboration with colleagues, patients, and other interprofessional teams (AANC, 2011). These other interprofessional teams can also involve legislature. Becoming a team player and an advocate for health can directly be done through writing letters of interest to the local legislature.…

    • 313 Words
    • 2 Pages
    Decent Essays
  • Great Essays

    Nurse Executive Summary

    • 1483 Words
    • 6 Pages

    Nurse Managers have a lot of responsibilities that call for management skills, leadership, dedication, and knowledge. They are accountable for achieving goals for the hospital and coordinating and organizing resources. “They must be directed toward balancing the needs of patients, the health care organization, employees, physicians, and self” (Sullivan, 2012, p. 41). The Pediatrics and Medical/Surgical Units at Memorial Hermann Sugar Land Hospital are under the direction of Pam Bourassa. Pam is a risk-taker, great communicator, and helps promote learning and growing in her staff.…

    • 1483 Words
    • 6 Pages
    Great Essays
  • Great Essays

    Bundle Payment Model

    • 1336 Words
    • 6 Pages

    Risk involved in participating in bundle payments are; financial risk, and operational risk. These risk can be eliminated when incentives are aligned with well integrated process. Implementation of bundle payment will prove to be the best system in improving care, reducing cost and coordinating…

    • 1336 Words
    • 6 Pages
    Great Essays
  • Improved Essays

    In the United States, medical services are not free and they certainly are not cheap, therefore reimbursement for these services is highly important. Today, health care reform is a hot topic with an emphasis on improving patient care and reducing the cost of medical services. Many providers currently use a fee-for-service reimbursement model, which is a quantity over quality method that allows providers to bill for services separately despite whether the quality of care was good or poor. Health care reformers aim to change this with new reimbursement models that highlight value over volume.…

    • 810 Words
    • 4 Pages
    Improved Essays
  • Improved Essays

    Clinically Integrated

    • 798 Words
    • 4 Pages

    This occurred when the Affordable Care Act (ACA) of 2011 included provisions to help promote clinical integration. In general, the act suggests that hospitals and health care organizations are expected to collaborate and improve clinical integration or the coordination of care across settings by expanding coverage, boost the effectiveness and efficiency of care, promote innovation, and control costs. Collaboration is comprised of physicians, hospitals, and other providers that share the responsibility and information about patients as they transition from one setting to another over the entire course of their care. Clinically integrated providers work together to develop and implement evidence-based clinical protocols, focusing on delivery of preventive care and coordinated management of high-cost and high-risk patients. The combination of these results allows these providers to identify opportunities for improvement and ensure adherence to protocols by utilizing shared information and technology to conduct ongoing clinical care…

    • 798 Words
    • 4 Pages
    Improved Essays
  • Improved Essays

    Value Based Reimbursement

    • 694 Words
    • 3 Pages

    According to the AMA, “Having several common frameworks for the new Medicare APMs will not only make it easier for (practice specialist) to create payment models that match their needs, but should also make it easier for Medicare and other payers to implement payment models for multiple specialties,” including small to medium sized practices. Meeting the quality components is exponentially easier and more accurate with an advanced EHR than paper-based reporting systems because files are indexed and searchable, dramatically reducing the time spent retrieving individual paper files, reviewing documents for relevant data and manually compiling the data for reporting. In addition, advancing care information components mean that in order to receive full points, practices must deploy certified EHR solutions, increasing use overtime. Maximizing Practice Potential in the MACRA…

    • 694 Words
    • 3 Pages
    Improved Essays
  • Improved Essays

    These reforms are firstly the Performance-based reimbursements, tied to excellence as well as competence metrics, offer incentives outcomes synchronization of a patient's care through various providers, such as physicians and nurses (Martinez, King, & Cauchi, 2016). Secondly, managed care which denotes healthcare structures that assimilate financing in addition to delivering amenities to insured persons by provisions with designated providers. Finally, are Bundled disbursements, referred to as incidents of care that are providing a lump sum to a team of providers operating as a squad to share for all amenities linked to a patient's precise…

    • 869 Words
    • 4 Pages
    Improved Essays
  • Superior Essays

    Medical Foundation Model

    • 1578 Words
    • 7 Pages

    In a real world, the integration of different branches of an organization brings about a solid support. Practically, invasion of clinic integration, hospitals and physicians can conduit separation and resolve competitions. In addition to the outcome of integration, the accountable care organization represents the most recent effort activate the process. Although, the in cooperation of providers create an opportunity to coordinate care through centralized scheduling, patient electronic health records, and innovative quality improvement programs, it helps with patient communication and transaction across the globe. There are basis that produces a guide to physician integration models for sustainable success.…

    • 1578 Words
    • 7 Pages
    Superior Essays
  • Improved Essays

    With the two roles that are compared here a non-clinical nurse administrators requires different skills than an advanced practicing nurse. Although the nurse administrator is not in direct patient care any longer, they are responsible for helping those in direct patient care utilize and follow not only the code of ethics also evidence based practice and facility policies. The nurse practitioner is directly involved with the patient and is a leader to her peers of nurses. Leadership and professionalism are two areas that the core competencies overlap, requiring excellent leadership and professionalism to all the different people within their practice and community. The differences between these two professions are position specific qualities that allow for the individual to perform their day to day daily tasks within the leadership role and return their knowledge and skills for the betterment of…

    • 984 Words
    • 4 Pages
    Improved Essays
  • Great Essays

    Nurse leaders must work with frontline staff to develop standardized care pathways in EHR systems that define order sets and select terminologies that are consistently describe the work that nurses perform. Nurse leaders must work with EHR vendors and technicians to structure the system in such a way that it helps them capture necessary clinical data. Nursing leadership should be leveraging the impact of each system implementation in order to achieve more effective care processes. Nursing leadership is the representation of the nursing staff as a whole. They are there to make sure that implementation of the system streamlines the workflow process.…

    • 1179 Words
    • 5 Pages
    Great Essays
  • Improved Essays

    The Medicare community has oversight by the Center for Medicare and Medicaid Services, (CMS). Healthcare organizations are contracted to provide quality healthcare options for consumers by CMS however; each plan has limitations in those plan that prevent the consumer from obtaining that quality care they expect. Some of the main concerns that prohibit streamlining the process are plans dropping doctor’s mid-year without sufficient notice to members, coverage problems not clearly identified in their marketing, exorbitant cost-share, high premiums, and limited coverage. Thankfully the Affordable Care Act has made it easier for members to get quality care. They have limited the risk factors which illuminates overwriting for individuals in the…

    • 406 Words
    • 2 Pages
    Improved Essays
  • Improved Essays

    Nursing Implications The expectation for all stakeholders in healthcare is for safe, quality care at a value cost. Healthcare leaders are responsible for setting the stage for quality outcomes and the largest impacting force is in the hands of nursing. Nurses have a high exposure to patients and processes requiring and buy-in for the activities that lead to positive outcomes as defined by internal financial drivers, the regulatory agencies, the third-party reimbursement agencies and the consumers. Transformational, authentic, and trustful leadership has been shown to a have significant impact on the desired outcomes.…

    • 439 Words
    • 2 Pages
    Improved Essays
  • Improved Essays

    The nurse who possesses leadership skills, more specifically transformational leadership skills, will have a vision of what and how the unit should…

    • 929 Words
    • 4 Pages
    Improved Essays