number of physicians and nurse practitioners (assume an equal number of physicians and nurse

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Question description

To deliver healthcare services, an ACO needs to create a competent workforce that can provide healthcare to the patients that are in the ACO. Some integrated ACO entities already have employed physicians and mid-level providers that receive salaries from the organization, whereas other non-integrated ACO entities need to invest in external relationships with independent physicians and other providers. Since ACOs do not have managerial control over non-employed providers, additional controls and incentives may be necessary to ensure that efficiency is maximized. ACOs also need to consider the number and mix of specialists (e.g., family practice vs internal medicine) and mid-level providers (e.g., physician assistants and nurse practitioners) in delivering primary care services that can promote value. Maximizing value requires appropriate workforce decisions on supply and incentives to encourage providers to minimize costs. For this Assignment, examine the Week 2 Assignment document and consider the efficiency in the supply of health services.

To prepare for this Assignment, review the scenario and Week 2 Assignment document provided to you by the Instructor. Based on the financial data, conduct a financial projection (revenues, expenses, and profit) which analyzes the efficiency in the supply of health services.

The Assignment

In a 2- to 3-page Word document that includes tables and/or calculations, make recommendations on the following: 

1) number of physicians and nurse practitioners (assume an equal number of physicians and nurse practitioners);

 2) reimbursement method: salary or fee-for-service; 

3) recommendations for financial incentives to address challenges of supplier-induced demand and ensure efficiency. Interpret the net profit from the ACO contract based on your recommendations. Support your recommendations with rationale, including how the financial calculations impacted your recommendations.

General Guidance on Assignment Length: Your Assignment should be 2−3 pages in length. Refer to the Week 2 Assignment Rubric for grading elements and criteria. Your Instructor will use the rubric to assess your work.


HEALTH AND MEDICARE 1 Reimbursement Strategies Name Instructor Course Title Date HEALTH AND MEDICARE 2 Reimbursement strategies The quest to lower health cost while maximizing on the quality has been a born of contention for quite a long time, professionals over decades have tried to put to the table substantial models that are intended to expand the health fraternity. Reimbursement strategies are simply new technologies that are meant to steer health care into a new era moving from the old and traditional way of fee for service. A number of models have been put forth to take care of acute illness both for inpatient and outpatient while those who suffer from chronic illness have been ignored. Setting a reimbursement payment is critical for primary care physicians and physician assistant in the provision of a comprehensive management care service, especially for patients with chronic conditions. There are a number of payment modes that range from manual to software, these include; intuit online payroll, QuickBooks online payroll and direct deposit reimbursement. The best reimbursement payment mode in such a case is direct deposit reimbursement because it does not require any validation process more so in dealing with patients with chronic diseases given the high expenditures attached to it. When considering direct deposit as a means of payment the alternative payment models must be given keen attention so that they align with the set up reimbursement payment strategy. The widely used alternatives include, fee for service, bundled payments, global capitations and the most commonly used is the shared savings (Zelman, 2014). The reimbursement strategy in this case that best suits the scenario is the value-based reimbursement which in essence tries to sort the issues of quality in relation to the service provided by the physicians, in the midst of all this the Accountable Care Organization while HEALTH AND MEDICARE 3 strive to lower costs as much as possible in order to cover a larger number of patients. Valuebased reimbursement revolves around three major payments but we are going to consider the bundle payment. The bundle payment strategy has four models which it takes into consideration to actualize its plan; these four models define in details the nature of the value-based reimbursement. Out of the four modes is the most commonly used are the second and the third while the first and fourth models are rarely used shown by the low uptake of customers. Just as it has been mentioned earlier bundle payment which is also known as episode-based payment refers to a single wholesome payment that can be made on a one time basis or in an episode as the name suggests for a specific treatment. This can suit well the scenario for patients with chronic conditions because they usually require specific treatment for instance those suffering from diseases like cancer or diabetes. The best part that comes with the bundle payment is that larger spectrums of physicians come your way and service is offered at low cost but of quality (Porter, 2013). Comparatively, value-based reimbursement strategy considers the major areas that make it suitable for this particular case, these are; coverage, coding and payment. Coverage takes care of the chronic conditions the patients are in so that special attention is given to their case; this further covers the Medicare device together with the drugs to be used by the patient but the fundamental issue is whether the private payer will consider the conditions and terms of the payment, this is usually the most important phase which if it fails to materialize then the whole strategy fails (McClellan, 2015). HEALTH AND MEDICARE 4 Alongside other alternative means of payment is the global capitation though it can handle the cases of quality while minimizing on cost the geographical dimension proves to be an obstacle for it, otherwise it would be suitable for paying medics who handle chronic conditions across the globe. The other payment mechanism is shared savings which has been widely accepted though it faces the challenge of coding which is difficult to interpret in terms of service provided. In addition the other necessary factor that can boost the value-based reimbursement strategy is the utilization management control, though this tend to incline so much to the side of fee for service it largely takes care of unnecessary cost while maximizing on quality just like the valuebased reimbursement. The utilization management covers three major facets, these are; fee for service, substantial savings on unnecessary cost of care and operational cost are always at their lowest even for patients who are under chronic conditions. The major key areas in this utilization control is the assessment of value and the management of costs, and closely only two strategies can make the utilization management compatible with reimbursement value-based strategy in relation to our scenario. These are the dominant and high-cost case of utilization management strategies (McClellan, 2015). In summation all these factors require financial agreements in one way or the other, be it the decision to reschedule an operation for a patient or delay admission for surgery for cancer patients. The use of codes has not been intensively used in this work but it really demands financial incentives in order to be successful in interpreting the financial resource in terms of the service provided. Value-based reimbursement strategy tries to take to consideration the aspect of cost minimization and quality maximization both from the two ends from the side of the patient and the service providers. HEALTH AND MEDICARE 5 Reference Zelman, W. N., McCue, M. J., Glick, N. D., & Thomas, M. S. (2014). Financial management of healthcare organizations: An introduction to fundamental tools, concepts and applications (4th ed.). San Francisco, CA: JosseyBass. McClellan, M. (2015). Accountable care organizations and evidence-based payment reform. Journal of the American Medical Association, 313(21), 2128–2130. Porter, M. E., Pabo, E. A., & Lee, T. H. (2013). Redesigning primary care: a strategic vision to improve value by organizing around patients’ needs. Health Affairs, 32(3), 516-525.

Tutor Answer

lemans
School: New York University

HEALTH AND MEDICARE
 



 
 
 
 
 
 
 
 
 
 

Reimbursement Strategies 
Name 
Instructor 
Course Title 
Date 

 

HEALTH AND MEDICARE 
 



Reimbursement strategies 
The  quest  to  lower  health cost while maximizing on the quality has been a born of contention for 
quite  a  long time, professionals over decades have tried to put to the table substantial models that 
are  intended  to  expand  the  health  fraternity.  Reimbursement  strategies  are  simply  new 
technologies  that  are  meant  to  steer  health  care  into  a  new   era  moving  from  the  old  and 
traditional  way  of  fee  for  service.  A  number  of  models have been put forth to take care of acute 
illness  both  for  inpatient  and  outpatient  while  those  who  suffer  from  chronic  illness  have  been 
ignored.  
Setting  a  reimbursement  payment   is  critical  for  primary  care  physicians  and  physician  assistant 
in  the  provision  of  a  comprehensive  management  care  service,  especially  for  patients  with 
chronic  conditions.  There  are  a  number  of  payment  modes  that  range  from  manual  to  software, 
these  include; intuit online payroll,  QuickBooks  online  payroll and direct deposit reimbursement. 
The  best  reimbursement  payment  mode  in such a case is direct deposit reimbursement because it 
does  not  require  any  validation  process  more  so  in  dealing  with  patients  with  chronic  diseases 
given  the  high  expenditures  attached  to  it.  When  considering  direct  deposit  as  a  means  of 
payment  the  alternative  payment  models  must  be given keen attention so that they align with the 
set  up  reimbursement  payment  strategy.  The  widely  used  alternatives  include,  fee  for  service, 
bundled  payments,  global  capitations  and  the  most  commonly  used  is  the  shared  savings 
(Zelman, 2014). 

Estimated  number  of  nurse  practitioners  and  physician  assistants  practicing 
primary care in the United States, 2010 

HEALTH AND MEDICARE 
 
Provider type 


Total 

Percent primary care 

Practicing primary care 

Nurse practitioners 

106,073 

52.0% 

55,625 

Physician assistants 

70,383 

43.4% 

30,402 

 
Nurse practitioners in primary care have taken 48% while subspecialty care have taken 52% which 
interpret that the priority is assigned to primary care nurse practitioners  in addition that physician 
assistants who are in primary care have taken 43% whereas physician assistants who are in 
subspecialty care have taken 57% which interpret that priority is given to subspecialty care physician 
assistants and all this can interpret that priority of specialty is important while for physician assistants 
is not important .and that may lead us to say that reimbursements and financial  management is 
directed in an equal way to serve both nurse practitioners and physician assistants.  

The  reimbursement  strategy  in  this  case  that  best  suits  the  scenario  is  the  value­based 
reimbursement  which  in   essence  tries  to  sort  the  issues  of  quality  in  relation  to  the  service  
provided  by  the  physicians,  in  the  midst  of  all  this  the   Accountable  Care  Organization  while 
strive  to  lower  costs  as  much  as  possible  in   order  to  cover  a  larger  number  of  patients. 
Value­based  reimbursement  revolves  around  ...

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Anonymous
Thanks, good work

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