Accountability Of Healthcare Providers Sample Paper
Accountability is a broad term that means taking responsibility for someone or some event. It could also mean owning up to mistakes that occur during the provision of care. Involves providing effective, safe, quality, and affordable healthcare. The focus of accountability in healthcare is the delivery of quality patient care. Accountability is thus crucial and indispensable. Inadequate accountability may result in substantial organizational damage. The benefits of accountability in healthcare include proper utilization of resources, provision of quality safe care, and building trust in the doctor-patient relationship (Kaufman et al., 2019) .
Defining Accountability Care Organization (ACO) and their impacts on health care providers:
Health care providers (specialists, surgeons, doctors, and nurses), hospitals, and other healthcare facilities can form networks that care for a specific patient population to optimize resources for improved care delivery. These networks are referred to as Accountable Care Organization (ACO). Provider cooperation, improved productivity, coordinated care, improved health outcomes, and improved patient health care experiences are the main goals of ACOs (Kaufman et al., 2019). ACOs advocate for health care providers’ financial accountability in specific populations by impacting traditional payment and delivery systems through incentives. ACOs play other various essential roles in influencing healthcare providers. ACOs inform healthcare coordination and thus facilitate better health outcomes and patients’ healthcare experiences. ACOs foster doctor-patient relationships and doctor-families relationships, which enhances the provision of holistic care with family inclusion (Kaufman et al., 2019). ACOs also promote the provision of affordable, high-quality care.
How ACOs differ from the health maintenance organizations (HMOs)
There are significant differences between the ACOs and HMOs. The ACOs focus on risk-sharing and quality performance through the provision of financial incentives and improved payment structures. Efficiency, effectiveness, and quality performance in-patient care are not accounted for in the HMOs. ACOs provide monetary rewards to the healthcare providers for the quality care they provide. However, they are sensitive to misuse and wastage of resources and focus on providing quality care as opposed to being profit-oriented (Heider and Mang, 2020).
On the other hand, HMOs do not pay attention to the quality of care provided but to profit realized from health care provision. ACOs are also distinguished from HMOs because they provide care without demanding patients to enroll in the organization. HMOs restrict their care to the specific populations that have enrolled in these organizations. The HMOs also tend to deal with complex health care settings that are often unmanageable, unlike the ACOs, which deal with local, simple, and manageable health care settings (Falkson and Srinivasan, 2020). The results are that the ACOs are more effective in delivering safe, quality, and affordable care than HMOs.
Roles of health information technology (HIT) in the newer models of care
EHRs, which are technological advances in health care, have been instrumental in detecting threats specific to patient diagnosis and alerting the health care providers accordingly. Integration of EHRs has helped improve patient care and promote patient safety. Medication errors have been a notorious cause of patient mortality, and with EHRs, medication errors and subsequent patient mortality are reduced. Paperwork has been dramatically reduced with the integration of EHRs in health care, saving time and energy wasted in retrieving patient records (Adjerid, Adler-Milstein & Angst, 2018). The use of technology has enhanced care delivery to patients even when they are at home.
Patients can schedule meetings with their doctors and benefit from consultation services while at the comfort of their homes. The use of HIT in health care promotes patient-centered care as it provides information to both patients and the care providers and provides means of communication between the care providers and the patients. Patients can access their online medical records and crucial information about their conditions. This has a significant bearing in health care because it improves patient awareness, patient cooperation in care provision and helps patients make informed decisions. HIT improves patient-doctor interactions and care coordination which promotes patient safety and delivery of quality patient care.
Benefit of hospitals accrue by partnering with primary care providers.
The integration of primary care and hospital care confer several benefits to patients. One such benefit is that the patients received informed standard care that is safe and of high quality. The patient’s healing is thus enhanced. The patients are hence less frequently readmitted therefore, they incur less health care costs. The use of EHRs is instrumental in improving communication between the hospital, patient, and primary care providers and, hence, fosters collaboration and, subsequently, delivering quality patient care.
Bundling payments and hiw they contain healthcare costs.
Bundling payments is instrumental in controlling and managing health care costs. Studies reveal that bundling payments lead to a substantial decrease in total health care costs (Wilcock et al., 2020). For example, health care in the United States usually accounted for 18% of the total government expenditure. With the introduction of bundling payments, these costs have markedly decreased. In addition to monetary gains, medical and other expenses that arise from the delivery of poor quality care were also reduced, and the overall quality of health care improved. Bundling payments are thus instrumental in controlling and containing health care costs. Bundled payments also help minimize unnecessary health care costs. For example, the bundled payments cut costs on the treatment of conditions that can be managed through changes in patients’ behaviors such as sedentary lifestyles and risky health behaviors. Saving money leads to a reduction in the health care costs, and thus, the bundling payments are helpful in containing health care costs.
Pay for performance (P4P) and how they improve quality care
Arguably, the pay for performance approach tends to improve health care through negative and positive reinforcements. In positive reinforcement, the health care providers are provided with monetary incentives as rewards for good performance. The incentive acts as a source of extrinsic motivation to the healthcare provider, who in turn adheres to quality healthcare practices leading to improved patient care. In negative reinforcement, penalties are introduced in cases of poor performance. Health care providers can be penalized for delivering sub-quality care or errors such as wrong medications. The penalties can include taking responsibility for total patient care costs. The healthcare providers are thus keen on providing safe and quality care to avoid penalties. This has the effect of improving the efficacy and efficiency of healthcare. Positive or negative reinforcements that include financial interventions can thus be essential in enhancing the quality of care.
Value-based purchasing program.
The value-based purchasing program (VBPP) is a program under the Centers for Medicaid and Medicare Services. The program is tailored to effectively equate Medicare payment systems to the quality of care offered in the in-patient department. The VBPP assesses the value of reimbursement systems that account for the most significant percentage of Medicare expenditure (Jha, 2017). The hospitals are ranked depending on the effectiveness and quality of care they provide rather than the quantity of services they offer. The aim is to ensure hospitals focus on the provision of adequate and quality care as opposed to delivering many services. The VBPP aims to improve patient health outcomes and create a positive patient experience during care delivery (Ryan et al., 2017). One of the significant interventions of VBPP is providing incentives to hospitals to enhance effective and efficient care by eradicating possible health care errors (Ryan et l., 2017). The VBPP minimizes errors and inappropriate practices in healthcare and also reinforces healthcare providers’ good performance.
Effects of value-based purchasing (VBP) programs on hospital reimbursements.
VBPP determines the amount collected by hospitals through Medicare compensations under IPPS (Inpatient Prospective Payment System). The IPPS disbursements are dependent auon the value of care delivered. The programs affect the in-patient healthcare payments.
Beneficiaries of value-based reimbursements.
The VBP program uses financial incentives to encourage the provision of high-quality care to the patients. The healthcare providers are compensated for their efforts, and the patients, on the other hand, receive quality care (Wilcock et al., 2020). Here, the patients and the healthcare providers’ organizations benefit from the VBPPs, but the healthcare providers’ organizations reap more benefits.
Measuring hospital performance using VBP program.
As mentioned earlier, the VBPPS are a function of the Centers for Medicare and Medicaid systems (CMS). The CMS collects and compares generated data from various hospitals for the periods in which the VBPPs were in progress. A hospital’s performance is analyzed and categorized as successful or failure from the scores determined from the analysis.
Accountability is an integral role of all health care providers. Healthcare providers should ensure that they provide holistic, quality, and safe care to the patients. They should make rational decisions that only convey the benefits to the patients and own up mistakes when they occur during care delivery. They should also be aware that they are responsible for safeguarding the patients from all the health risks that surround them. They must uphold and maintain quality patient care that addresses patients’ needs effectively. The government and other stakeholders also play a significant role in enhancing accountability. Accountability in healthcare is essential as it informs practice and improves the performance of health care practitioners.
- Adjerid, I., Adler-Milstein, J., & Angst, C. (2018). Reducing Medicare spending through electronic health information exchange: the role of incentives and exchange maturity. Information Systems Research, 29(2), 341-361. https://doi.org/10.1287/isre.2017.0745
- Falkson, S. R., & Srinivasan, V. N. (2020). Health Maintenance Organization (HMO). StatPearls [Internet]. Available from https://www.ncbi.nlm.nih.gov/books/NBK554454/
- Heider, A. K., & Mang, H. (2020). Effects of Monetary Incentives in Physician Groups: A Systematic Review of Reviews. Applied Health Economics And Health Policy, 1-13. https://doi.org/10.1007/s40258-020-00572-x
- Jha, A. K. (2017). Value-based purchasing: time for reboot or time to move on?. JAMA, 317(11), 1107-1108. doi:10.1001/jama.2017.1170
- Kaufman, B. G., Spivack, B. S., Stearns, S. C., Song, P. H., & O’Brien, E. C. (2019). Impact of accountable care organizations on utilization, care, and outcomes: a systematic review. Medical Care Research and Review, 76(3), 255-290. https://doi.org/10.1177%2F1077558717745916
- Wilcock, A. D., Barnett, M. L., McWilliams, J. M., Grabowski, D. C., & Mehrotra, A. (2020). Association Between Medicare’s Mandatory Joint Replacement Bundled Payment Program and Post–Acute Care Use in Medicare Advantage. JAMA Surgery, 155(1), 82-84. doi:10.1001/jamasurg.2019.3957