Running head: REIMBURSEMENT METHODS OF PAYMENT Reimbursement Methods of Payment Misty Fresenburg Professor Wilson 11/29/2019 1 REIMBURSEMENT METHODS OF PAYMENT 2 Reimbursement methods Introduction The first type of reimbursement is free for service. This type of model brings ion the negotiation of specific rates forever service and products with additional controls and caremanagement components need to be part of the negotiation. This means the doctors and other healthcare workers are paid for each particular task they undergo. The health care service is paid according to the volume and quantity of services provided in the unit. The payment does not depend on the outcome but only on the work provided by the healthcare providers and doctors. The doctors and workers end up motivated to work more motivated to be paid more. Healthcare workers also can be reimbursed with bundled payments for specified episodes of care undertaken. This means the worker is paid only once into a single bundled payment amount for the services offered to the patient over an episode. The care episode is the delivery period for a condition to be delivered over a certain period. It is broader than the traditional case of reimbursement rate. This ensures coordination in the field of care and the prevention of redundant or medical services that are not necessary to be undertaken (Allareddy, 2019). Shared saving is another form of reimbursement for healthcare providers. This model provides incentives that are positive and lowers the risk of the health providers improving the coordination of care and results of an identified group of a population. It is included in new care models and recent reforms of payments which allows providers to share savings the acquire hence promoting efficiency. This requires the definition of methodology and related results for determining the shared saving. Eligible providers, hospitals and suppliers can join a program to improve outcomes and increase the value of care. REIMBURSEMENT METHODS OF PAYMENT 3 The best type of reimbursement method is the bundled payments bundle. The workers of healthcare get to be paid at a single time for all the care they have given to the patients. This is the most effective type of method in increasing the type of health care being provided to the patients of healthcare unite. The advantages of the method also are more than the disadvantages of using the method to reimburse the workers. When compared to other methods, the disadvantages are few. This type of method is recommended for use and should be adopted for effectiveness. Advantages of the bundle method Patients costs are moderated by this type of method. There is no set price the price is clear and can be known ahead of time. This will help the patients to pay less when it comes to the cost of the hospitals and also help them budget for the prices properly. This method eliminates unnecessary types of services since the healthcare workers are working together under the same budget. This enables the method to be more effective and cost-efficient compared to the other methods. The patients normally go for cheap service yet efficient. The method doesn’t consider quantity but the quality of the care they give their patients. They do not focus on the revenue they will gain from undertaking a procedure but focus on the type of service they offer to the patients. This helps prevent complications with the patients due to unsatisfactory procedures or service. The bundle method also prevents the workers from working in a health unit from being fragmented but being united. This is evident due to the workers working under a single bundle (Scott, 2019). This helps improve the coordination between the health providers hence providing quality and effective service to their patients. Disadvantages of the bundle payment method REIMBURSEMENT METHODS OF PAYMENT 4 There is a limitation of the effectiveness of the method. The orthopedic surgeons undergo procedures with defined episodes of expenses and care thou, not all the procedures turn out as expected. Bundle payment can affect people in the workplace who are not used to working with them causing the worker to strain themselves. This also affects the workers in the workforce with no infrastructure, transparency, and technology. During the distribution of money to the workers, it can be hard to distribute since each provider contribute can be of different patients involved in a health care episode. Impacts of the methods of reimbursement The bundled payment can be seen as a combination of both the fee to service reimbursement and capitation. If a service provider has a situation that is server in nature than it is expected in the pricing of the episode, they get underpaid for the episode of care undertaken. This can be seen in capitation where severity levels are importantly considered in an episode of care. When the severity is noted in the pricing, then the bundle method promotes good care since the workers can get more revenue by decreasing their costs (Miguel,2019). Payers may ask the providers to change their business to focus on value and not only cost. This is the intersection of quality and cost. this is to encourage the passage of good quality under low-cost t to the payers. The value-based reimbursement models combine to reward the doctors or punish them depending on the achievement of the goas placed for them. An effective type of physician is the type who effectively manages a patient before developing a chronic condition and being taken to the hospital. The physicians are supposed to focus on the well-being of the patient and not on the profitability of their company. The healthcare unit needs to adopt an appropriate reimbursement method. REIMBURSEMENT METHODS OF PAYMENT 5 Reference Elangovan, S., & Allareddy, V. (2019). Value-Based Payment Approaches. The Journal of the American Dental Association, 150(6), 485. Northup, C. J., & Scott, J. D. (2019). Bundled Payments for Bariatric Surgery. In Quality in Obesity Treatment (pp. 177-186). Springer, Cham. Vieira-Sousa, E., Eusébio, M., Ávila-Ribeiro, P., Khmelinskii, N., Cruz-Machado, A. R., Martins-Rocha, T., ... & Miguel, C. (2019). SAT0366 GENDER DIFFERENCES IN PSORIATIC ARTHRITIS–IMPACT ON TUMOR NECROSIS FACTOR INHIBITORS PERSISTENCE AND RESPONSE. Running Head: AMBULATORY SURGERY CENTER Ambulatory Surgery Center (ASC) Misty Fresenburg Professor Wilson Unit 1 IP November 28,1979 1 AMBULATORY SURGERY CENTER 2 The type of facility I am recommending is ambulatory surgery center (ASC). ASC facilities primarily deal with providing same-day surgical care such as preventive and diagnostic measures (Ambulatory Surgery Centers Association, 2008). The reason I propose ASC over other facilities is due to their ability to provide convenient alternative outpatient procedures hence transforming outpatient experience for millions of people across the country. ASC have maintained a strong track of care as well as positive patient outcomes that makes them very suitable choice. Further, the reason I opted for this facility is because it provides patients with surgeries at a significantly lower cost compared to hospitals. More importantly, ASC minimize the patient’s risk of exposure to infection a common phenomenon in hospitals since the patients who visit ASC do so for surgery and not to get treatment from diseases and sicknesses (Al-Amin & Housman, 2012). Hence, compared to other facilities such as hospitals, ASCs are more preferable as healthcare facilities transform from inpatient to outpatient care. ASC are healthcare institutions where patients can undergo surgeries without the need for hospital admission. The services provided by ASC are cost-effective and provide patients with a more convenient environment that most hospitals can provide. Patients who opt for surgeries in ASC facilities are able to arrive on their scheduled day of the procedure, undergo the procedure in well-equipped operating room and are able to recover with the help of highly qualified nurses (Al-Amin & Housman, 2012). All of this is achieved without patients being admitted to a hospital. Regardless of their age, all patients are able to significantly benefit from the ASCs services. ASCs provide their services in diverse manner with some ASCs specializing in providing services in a given specialty like sports medicine and eye care whereas other offer surgeries in diverse range of specialties. Consequently, ASCs are progressively an outstanding AMBULATORY SURGERY CENTER 3 option for managed care as a way of guaranteeing high-quality and effectual outpatient surgical care. While most surgeries continue to be performed in hospitals, these occurrence is estimated to change. For example, in 2005, 59% of total outpatient surgeries were conducted in hospitals whereas only 41% of the surgeries were performed in ASC. However, current statistics have approximated that the number is bound to change by 2020 whereby only 40% of total outpatient surgeries in the country will be conducted in hospitals (Ambulatory Surgery Centers Association, 2008). Notably, current research findings indicate that there are minimal chances of patients from ASC operations ending up in the emergency room or seeking hospital inpatient services. Further, the rates of infection in ASC has been approximated to be half that reported in hospitals. Patient satisfaction is ASC’s trademark. According to a survey on Medicare beneficiaries who had received ASC procedures by the US Department of Health and Human Services’ Office of the Inspector General, 98% of the individuals where contended with their surgical procedure, outcomes, as well as experience (Wiggins, Peterson & Moss, 2015). There are numerous reasons why patients and physicians opt for ASC surgical procedures including the profound professionalism, quality, and safety that is provided in ASC. Most of the medical staff in over 75% of ASCs across the country have a certified rate exceeding 90%. A report conducted in 2007 indicated that in the course of a three month duration, 71% of ASC did not experience any complication over 1,000 patient happenstances (Ambulatory Surgery Centers Association, 2008). On the other hand, 69% of these ASCs didn’t refer their patients to hospital inpatient care or the emergency department. Among 1,000 patients operated in ASC, over 90% of ASC experience three or less cases of infections per 1,000 patients operated. Remarkably, available studies AMBULATORY SURGERY CENTER 4 indicate that the quality of care provided under ASC often equals or exceeds that provided under outpatient surgery care (Owens et al., 2014). There are also numerous other reasons people and physicians opt for ASC operations including reliable services as well as the convenience of their scheduling. For instance, close to a third of ASC facilities identify that over 90% of their surgical procedures begin within 7 minutes of the scheduled time of the surgery. The procedures procured by ASCs are diverse in nature. In overall, ASCs focus primarily on surgery that entails pain management as well as diagnostic surgery services. Currently, most knee, eye, spine, and shoulder among other surgeries are conducted by ASC. As of 2016, the three procedures commonly procured by ASCs were cataract surgery using intraocular lens insert, upper gastrointestinal endoscopy utilizing biopsy, as well as colonoscopy that integrated biopsy (Hollenbeck et al., 2015). In general, most of the services offered in ASC could be termed as procedures. The ASC will adopt a highly efficient staffing model when hiring clinical staff. The ASC facility staff and administrators will conduct both traditional as well as non-traditional responsibilities. Hence, the staff will have to put on many hats on a particular day. A registered nurse will entirely be responsible for the patient care in the facility. The RN must have a license provided after completing the National Council Licensure Examination for Registered Nurses in order to work at the facility. Two nurses will also be given the responsibility of infection prevention as well as monitoring the compliance of the facility to the infection control program. The nurses must complete a 2-year associate’s degree in nursing in order to become certified nurses. AMBULATORY SURGERY CENTER 5 The surgical technician will be responsible for arranging and organizing the operating room and making sure all the critical equipment are prepped and collected. Because of the nature of their jobs, the surgical technician will also fill the role of a materials coordinator with both organization and prioritization being critical in both job specifications. The surgical coordinator will be responsible for purchasing supplies, examining special orders, keeping record of purchases, receiving products, and being responsible for shipment received as a materials coordinator. Other team members will be tasked with assisting the surgical technician in restocking supply regions and receiving products. In order to qualify for the position, the surgical technician must have a certificate from a certified training program. A nurse manager will also be present at the ASC facility and will play both the roles of patient care as well as administration. The nurse manager will exercise managerial authority over the other clinical staff at the facility. The nurse manager must be an expert in both clinical duties including patient care as well as administrative duties such as staff management. The NM must be organized and able to tap from the assistance of the other staff members in order to achieve tasks. The facility will work with numerous physicians who will be responsible for procuring various surgical procedures. A safety officer will be responsible for helping with staff educating doing audits, as well as collecting items for meetings etc. An applicant must’ve completed postsecondary education and attained specialized training in order to qualify for the position. The physicians the ASC will work hand in hand with must possess training medical licenses. Ultimately, front office personnel are another important part of the ASC facility. These personnel are responsible for putting on numerous hats in a single day. They will be responsible for registration, reception, scheduling, medical records, patient collections, as well as verification AMBULATORY SURGERY CENTER and authorization of benefits. In other cases, they will help administrators with tasks such as personnel file maintenance, payroll, onboarding, as well as benefits administration. Due to the diversity of their profession, their unique skills shouldn’t be overlooked. The applicants will have to meet the following requirements to qualify for the position, completed a hospitality related course, successful work experience, well informed on office procedure and accounting principles, ability to maintain office equipment. 6 AMBULATORY SURGERY CENTER 7 References Ambulatory Surgery Centers Association, (2008). What Are Ambulatory Surgery Centers? Retrieved from: https://www.inova.org/sites/default/files/Services/surgical_services/PDFs/ambulatorysurgery-centers-brochure.pdf Al-Amin, M., & Housman, M. (2012). Ambulatory surgery center and general hospital competition: entry decisions and strategic choices. Health care management review, 37(3), 223-234. Hollenbeck, B. K., Dunn, R. L., Suskind, A. M., Strope, S. A., Zhang, Y., & Hollingsworth, J. M. (2015). Ambulatory surgery centers and their intended effects on outpatient surgery. Health services research, 50(5), 1491-1507. Owens, P. L., Barrett, M. L., Raetzman, S., Maggard-Gibbons, M., & Steiner, C. A. (2014). Surgical site infections following ambulatory surgery procedures. Jama, 311(7), 709-716. Wiggins, C., Peterson, T., & Moss, C. (2015). Ambulatory surgery centers‫ ׳‬use of Health Information Technology. Health Policy and Technology, 4(2), 100-106.
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