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.
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Explanation & Answer
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).
Estimated number of nurse practitioners and physician assistants practicing
primary care in the United States, 2010
HEALTH AND MEDICARE
Provider type
3
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 ...