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1.
J Nurs Adm ; 53(1): 12-18, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36542439

RESUMO

OBJECTIVE: The objective of this multihospital study was to investigate how the intervention of coaching to bedside shift report (BSR) correlates with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) outcomes and relates to Centers for Medicare and Medicaid Services (CMS) Hospital Value-Based Purchasing (VBP) Program points over a 4-year period (2017-2020) for an acute care hospital health system. BACKGROUND: Hospital leaders' responsibilities include intertwined areas of patient experience and fiscal accountability. Coaching to BSR is reported to have numerous benefits to the patient's experience. Published studies completed with hospital systems evaluating the intervention of coaching to BSR and how it correlated to patient experience and VBP are limited. METHODS: Coaching to BSR was implemented at 16 adult acute care hospitals. Patient-reported BSR rates were collected in tandem with HCAHPS for 4 years. Statistical correlations were assessed between patient-reported BSR and HCAHPS and consequential effect on VBP dimension scores. RESULTS: Coaching to BSR had a significant impact on top- and bottom-box "rate the hospital" HCAHPS scores at a system and hospital level. Value-based purchasing points and percentages increased over 2017-2020, potentially leading to lower CMS penalty claims over the period the BSR was implemented. CONCLUSIONS: Coaching is a key factor when creating a favorable patient experience. The implementation and sustainability of coaching to BSR may result in improved patient experience ratings and increase VBP point accumulation to hospital systems.


Assuntos
Tutoria , Idoso , Adulto , Humanos , Estados Unidos , Aquisição Baseada em Valor , Medicare , Satisfação do Paciente , Hospitais , Pessoal de Saúde
3.
JAMA Health Forum ; 3(9): e222723, 2022 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-36218946

RESUMO

Importance: The original Home Health Value-Based Purchasing (HHVBP) model provided financial incentives to home health agencies for quality improvement in 9 randomly selected US states. Objective: To evaluate quality, utilization, and Medicare payments for home health patients in HHVBP states compared with those in comparison states. Design, Setting, and Participants: This cohort study was conducted in 2021 with secondary data from January 2013 to December 2020. A difference-in-differences design and multivariate linear regression were used to compare outcomes for Medicare and Medicaid beneficiaries who received home health care in HHVBP states with those in 41 comparison states during 3 years of preintervention (2013-2015) and the subsequent 5 years (2016-2020). Exposures: Home health care provided by a home health agency in HHVBP states and comparison states. Main Outcomes and Measures: Utilization (unplanned hospitalizations, emergency department visits, skilled nursing facility [SNF] visits) for Medicare beneficiaries within 60 days of beginning home health, Medicare payments during and 37 days after home health episodes, and quality of care (functional status, patient experience) during home health episodes. Results: Among 34 058 796 home health episodes (16 584 870 beneficiaries; mean [SD] age of 76.6 [11.7] years; 60.5% female; 11.2% Black non-Hispanic; 79.5% White non-Hispanic) from January 2016 to December 2020, 22.6% were in HHVBP states and 77.4% were in non-HHVBP states. For the HHVBP and non-HHVBP groups, 60.4% and 61.0% of episodes were provided to female patients; 10.0% and 13.6% were provided to Black non-Hispanic patients, and 82.4% and 75.2% were provided to White non-Hispanic patients, respectively. Unplanned hospitalizations decreased by 0.15 percentage points (95% CI, -0.30 to -0.01) more in HHVBP states, a 1.0% decline compared with 15.7% at baseline. The use of SNFs decreased by 0.34 percentage points (95% CI, -0.40 to -0.27) more in HHVBP states, a 6.9% decline compared with the 4.9% baseline average. There was an association between HHVBP and a reduction in average Medicare payments per day of $2.17 (95% CI, -$3.67 to -$0.68) in HHVBP states, primarily associated with reduced inpatient and SNF services, which corresponded to an average annual Medicare savings of $190 million. There was greater functional improvement in HHVBP states than comparison states and no statistically significant change in emergency department use or most measures of patient experience. Conclusions and Relevance: In this cohort study, the HHVBP model was associated with lower Medicare payments that were associated with lower utilization of inpatient and SNF services, with better or similar quality of care.


Assuntos
Medicare , Aquisição Baseada em Valor , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Medicaid , Instituições de Cuidados Especializados de Enfermagem , Estados Unidos
4.
Front Public Health ; 10: 882715, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36299751

RESUMO

Beginning in the early 2010s, an array of Value-Based Purchasing (VBP) programs has been developed in the United States (U.S.) to contain costs and improve health care quality. Despite documented successes in these efforts in some instances, there have been growing concerns about the programs' unintended consequences for health care disparities due to their built-in biases against health care organizations that serve a disproportionate share of disadvantaged patient populations. We explore the effects of three Medicare hospital VBP programs on health and health care disparities in the U.S. by reviewing their designs, implementation history, and evidence on health care disparities. The available empirical evidence thus far suggests varied impacts of hospital VBP programs on health care disparities. Most of the reviewed studies in this paper demonstrate that hospital VBP programs have the tendency to exacerbate health care disparities, while a few others found evidence of little or no worsening impacts on disparities. We discuss several policy options and recommendations which include various reform approaches and specific programs ranging from those addressing upstream structural barriers to health care access, to health care delivery strategies that target service utilization and health outcomes of vulnerable populations under the VBP programs. Future studies are needed to produce more explicit, conclusive, and consistent evidence on the impacts of hospital VBP programs on disparities.


Assuntos
Medicare , Aquisição Baseada em Valor , Idoso , Estados Unidos , Humanos , Qualidade da Assistência à Saúde , Atenção à Saúde , Hospitais
5.
JAMA Health Forum ; 3(7): e221956, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35977225

RESUMO

Importance: Safety-net hospitals, which have limited financial resources and care for disadvantaged populations, have lower performance on measures of patient experience than non-safety-net hospitals. In 2011, the Centers for Medicare & Medicaid Services Hospital Value-Based Purchasing (VBP) program began tying hospital payments to patient-reported experience scores, but whether implementation of this program narrowed differences in scores between safety-net and non-safety-net hospitals is unknown. Objective: To evaluate whether the VBP program's implementation was associated with changes in measures of patient-reported experience at safety-net hospitals compared with non-safety-net hospitals between 2008 and 2019. Design Setting and Participants: This cohort study evaluated 2266 US hospitals that participated in the VBP program between 2008 and 2019. Safety-net hospitals were defined as those in the highest quartile of the disproportionate share hospital index. Data were analyzed from December 2021 to February 2022. Main Outcomes and Measures: The primary outcomes were the Hospital Consumer Assessment of Healthcare Providers and Systems global measures of patient-reported experience and satisfaction, including a patient's overall rating of a hospital and willingness to recommend a hospital. Secondary outcomes included the 7 other Hospital Consumer Assessment of Healthcare Providers and Systems measures encompassing communication ratings, clinical processes ratings, and hospital environment ratings. Piecewise linear mixed regression models were used to assess annual trends in performance on each patient experience measure by hospital safety-net status before (July 1, 2007-June 30, 2011) and after (July 1, 2011-June 30, 2019) implementation of the VBP program. Results: Of 2266 US hospitals, 549 (24.2%) were safety-net hospitals. Safety-net hospitals were more likely than non-safety-net hospitals to be nonteaching (67.6% [371 of 549] vs 53.1% [912 of 1717]; P < .001) and urban (82.5% [453 of 549] vs 77.4% [1329 of 1717]; P = .01). Safety-net hospitals consistently had lower patient experience scores than non-safety-net hospitals across all measures from 2008 to 2019. The percentage of patients rating safety-net hospitals as a 9 or 10 out of 10 increased during the pre-VBP program period (annual percentage change, 1.84%; 95% CI, 1.73%-1.96%) and at a slower rate after VBP program implementation (annual percentage change, 0.49%; 95% CI, 0.45%-0.53%) at safety-net hospitals. Similar patterns were observed at non-safety-net hospitals (pre-VBP program annual percentage change, 1.84% [95% CI, 1.77%-1.90%] and post-VBP program annual percentage change, 0.42% [95% CI, 0.41%-0.45%]). There was no differential change in performance between these sites after the VBP program implementation (adjusted differential change, 0.07% [95% CI, -0.08% to 0.23%]; P = .36). These patterns were similar for the global measure that assessed whether patients would definitely recommend a hospital. There was also no differential change in performance between safety-net and non-safety-net hospitals under the VBP program across measures of communication, including doctor (adjusted differential change, -0.09% [95% CI, -0.19% to 0.01%]; P = .08) and nurse (adjusted differential change, -0.01% [95% CI, -0.12% to 0.10%]; P = .86) communication as well as clinical process measures (staff responsiveness adjusted differential change, 0.13% [95% CI, -0.03% to 0.29%]; P = .11; and discharge instructions adjusted differential change, -0.02% [95% CI, -0.12% to 0.07%]; P = .62). Conclusions and Relevance: This cohort study of 2266 US hospitals found that the VBP program was not associated with improved patient experience at safety-net hospitals vs non-safety-net hospitals during an 8-year period. Policy makers may need to explore other strategies to address ongoing differences in patient experience and satisfaction, including additional support for safety-net hospitals.


Assuntos
Medicare , Aquisição Baseada em Valor , Idoso , Estudos de Coortes , Hospitais , Humanos , Assistência ao Paciente , Estados Unidos
7.
J Hosp Med ; 17(7): 517-526, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35729856

RESUMO

INTRODUCTION: As healthcare organizations examine the associated benefits of employing a larger hospitalist workforce, there is a need to better understand the association with patients' quality, experience, and efficiency. However, there is a lack of information regarding how hospital use of hospitalists over time influences hospital scoring on quality programs, such as the Center for Medicare and Medicaid Services (CMS) Hospital Inpatient Value-Based Purchasing (HVBP) Program. This study examines the association between hospitalist staffing between 2014 and 2019 and HVBP scores. METHODS: We used a cross-sectional panel study design. Total Performance Score (TPS) and its domains were obtained from CMS from 2014 to 2019 and merged with the American Hospital Association Annual Survey Database. We utilized random-effects multivariable panel regression models and zero-inflated negative binomial regression to examine the association between the hospitalist-staffing ratio and the HVBP Program. All models were adjusted for hospital characteristics. RESULTS: A total of 2126 hospitals were included in the study. The average ratio of hospitalists per staffed bed was 0.06, with a standard deviation of 0.15. This study suggests that hospitals that employ a higher percentage of hospitalists see improvement in their overall TPS (ß = 5.40; p < .001), Patient Experience (ß = 2.49; p <.05), and Efficiency (incidence-rate ratio= 1.41; p < .001) domain. However, the Clinical Care domain was no different in organizations employing more hospitalists. CONCLUSION: There are benefits associated with TPS, Patient Experience, and Efficiency from employing hospitalists. Managers should seek opportunities to leverage hospitalists' expertise in providing care, particularly in improving care processes.


Assuntos
Médicos Hospitalares , Idoso , Estudos Transversais , Atenção à Saúde , Hospitais , Humanos , Medicare , Estados Unidos , Aquisição Baseada em Valor
8.
J Healthc Manag ; 67(2): 89-102, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35271520

RESUMO

GOAL: We examined whether higher skilled nursing facility (SNF) lagged profitability is associated with a lower 30-day all-cause all-payer risk-adjusted hospital readmission rate. Our aim was to provide insight into whether SNFs with limited financial resources are able to respond to incentives to lower their readmission rates to hospitals. METHODS: We used data from 2012-2016 to estimate a fixed effects (FE) model with a time trend. Our data included financial data from the Centers for Medicare & Medicaid Services Healthcare Cost Report Information System SNF cost reports, facility characteristics including the all-cause all-payer risk-adjusted unplanned 30-day readmission rate from the LTCFocus (Long-Term Care Focus) project at Brown University, and county-level market variables from the Area Health Resource File. We also examined the relationship for a shorter time frame (2012-2015) after stratifying the sample by system membership or ownership. PRINCIPAL FINDINGS: SNFs with an increase in the lagged operating margin showed a statistically significant, small decrease (<.01 percentage point) in the risk-adjusted readmission rate. The results were robust for different time periods and model specifications. Fixed effects model estimates for SNFs in the highest quartile of percentage of Medicaid patients (≥73.9%) had a lagged operating margin coefficient that is almost four times as large as the coefficient of the FE model with all SNFs. APPLICATION TO PRACTICE: SNFs have an important role in achieving the national priority of reducing hospital readmissions. The study findings suggest that managers of SNFs should not see low profitability as an obstacle to reducing readmission rates, which is good news given the low average profitability of SNFs. Further, reductions in profitability due to penalties incurred from the recently implemented Medicare Skilled Nursing Facility Value-Based Purchasing Program may not limit SNFs' ability to lower hospital readmission rates, at least initially. However, policymakers may need to determine whether additional resources to high Medicaid SNFs can lower readmission rates for these SNFs.


Assuntos
Readmissão do Paciente , Instituições de Cuidados Especializados de Enfermagem , Idoso , Humanos , Medicare , Alta do Paciente , Estados Unidos , Aquisição Baseada em Valor
9.
JAMA Netw Open ; 5(2): e220721, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-35226075

RESUMO

IMPORTANCE: The new Medicare Skilled Nursing Facility Value-Based Purchasing program (SNF VBP) seeks to improve patient outcomes by awarding financial incentives or penalties based on 30-day hospital readmission rates. Skilled nursing facilities (SNFs) can avoid a penalty through low baseline readmission rates or improvement over time. OBJECTIVE: To assess the baseline performance and improvement over time of SNFs in the SNF VBP program. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined readmission rates, financial penalties and incentives, and facility and patient characteristics associated with these outcomes at 14 959 US SNFs that received Medicare payments between January 1, 2015, and December 31, 2019. MAIN OUTCOMES AND MEASURES: Outcomes were readmission rates and financial penalties by facility. The SNFs were classified as improvers in the analysis if they had better improvement scores than baseline scores under the program and achievers if they had higher baseline scores than improvement scores. RESULTS: Of 14 959 SNFs studied, 1849 (12.3%) were assigned their improvement score as their performance score in the first year of the program. Of these, 1167 (63.1%) received a financial penalty, whereas 374 (20.2%) received a bonus. Only 52 facilities that performed poorly at baseline (0.3% of all SNFs and 0.7% of below-median performers) were able to improve enough to avoid a financial penalty, despite large improvements in readmission rates. Improver SNFs treated larger racial minority populations (mean [SD], 74.57% [23.42%] White in the improver group vs 79.15% [22.18%] in the achiever group) and were located in counties with larger minority populations (mean [SD], 15.48% [14.05%] Black in the improver group vs 11.57% [12.72%] Black in the achiever group). The most important predictors of improvement were related to SNF finances, such as operating margin (mean [SD], -0.74 [13.87]) and occupancy rates (mean [SD], 79.93 [14.81]). CONCLUSIONS AND RELEVANCE: This cross-sectional study suggests that the SNF VBP program did not offer a viable path for nearly all low-performing SNFs to avoid financial penalties through improved readmission rates.


Assuntos
Readmissão do Paciente , Instituições de Cuidados Especializados de Enfermagem , Idoso , Estudos Transversais , Humanos , Medicare , Estados Unidos , Aquisição Baseada em Valor
10.
J Gerontol Nurs ; 48(2): 31-35, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35103523

RESUMO

Advance care planning (ACP) is an important component of person-centered care for older adults in nursing facilities. Although nursing facilities have a statutory obligation to offer ACP to residents, there are no minimum training requirements for staff. Lack of consistent ACP training contributes to significant variability in ACP conversation quality, inaccurate or incomplete documentation of preferences, and infrequent re-evaluation of prior decisions. Indiana added ACP training for nursing facility staff to the Value-Based Purchasing formula for 2019. Facilities received 5 points (of a 100-point total formula) if at least one staff member completed the designated ACP training during the year. ACP Foundations Training was developed by faculty at Indiana University and made available to all Indiana nursing facilities. A total of 1,087 participants, representing 94.2% (501 of 532) Indiana nursing facilities, completed the training. Approximately every participant (99.4%) agreed that the training had practical value. This academic-government partnership was successful in providing basic information about ACP to staff at most nursing facilities across Indiana and offers a model for states to provide critical educational content to nursing facility staff by incentivizing training. [Journal of Gerontological Nursing, 48(2), 31-35.].


Assuntos
Planejamento Antecipado de Cuidados , Aquisição Baseada em Valor , Idoso , Comunicação , Documentação , Humanos , Casas de Saúde
11.
J Telemed Telecare ; 28(5): 360-370, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32558612

RESUMO

INTRODUCTION: Previous studies indicated that telehealth services may improve hospital performance. However, the extent to which these telehealth provisions would improve hospital total performance score under the hospital value-based purchasing (HVBP) programme is not clear. The aim of this study is to examine the association between telehealth provision and hospital performance. METHODS: We performed a retrospective analysis of the association between the provision of telehealth services and 2699 hospital's total performance score (TPS) on the 2018 HVBP programme and its four domains. Multivariate regression models were used to analyse TPS and hospital performance on each domain. Telehealth services offered by a hospital was categorically operationalized as hospitals with no telehealth services, with one to two telehealth services, and with three or more telehealth services. RESULTS: Hospitals with one to two telehealth services have TPS (ß coefficient = 1.50; 95% confident intervals (CI): 0.28, 2.73; p < 0.05) and hospitals with three or more telehealth services have higher efficiency and cost reduction (ß = 1.10; 95% CI: 0.32, 1.87; p < 0.01) domain scores. However, the impact of telehealth on clinical care, person and community engagement, and safety domain scores was not significant. DISCUSSION: The expansion of hospital telehealth service provision can improve not only the efficiency of care, but also the total performance of the hospital. Since total performance is directly associated with hospital payments from the government, these findings have significant practice and policy implications. In addition, the effect of telehealth on other quality measures such as clinical care and safety needs further investigation.


Assuntos
Telemedicina , Aquisição Baseada em Valor , Hospitais , Humanos , Estudos Retrospectivos
12.
Med Care Res Rev ; 79(1): 90-101, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-33233999

RESUMO

The Home Health Value-based Purchasing (HHVBP) demonstration, incorporating a payment formula designed to incentivize both high-quality care and quality improvement, is expected to become a national program after 2022, when the demonstration ends. This study investigated the relationship between costs and several quality dimensions, to inform HHVBP policy. Using Medicare cost reports, OASIS and Home Health Compare data for 7,673 home health agencies nationally, we estimated cost functions with instrumental variables for quality. The estimated net marginal costs varied by composite quality measure, baseline quality, and agency size. For four of the five composite quality measures, the net marginal cost was negative for low-quality agencies, suggesting that quality improvement was cost saving for this agency type. As the magnitude of the net marginal cost is commensurate with the payment incentive planned for HHVBP, it should be considered when designing the incentives for HHVBP, to maximize their effectiveness.


Assuntos
Serviços de Assistência Domiciliar , Sistema de Pagamento Prospectivo , Idoso , Humanos , Medicare , Qualidade da Assistência à Saúde , Estados Unidos , Aquisição Baseada em Valor
13.
Am J Med Qual ; 37(2): 160-165, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34117166

RESUMO

Quality measurement is an intrinsic component of value-based purchasing, yet the quality measures currently in use for Value-Based Purchasing Programs (VBPs) are generally derived from a potpourri of measures originally built for other purposes. Only a handful of VBPs have definitively shown savings or expanded nationally. We suggest that to shift the health care reimbursement system in the United States to paying for value, quality measures used in VBPs should be vetted as "fit for purpose." We advocate that quality measures deemed "fit" for VBPs be defined primarily by the impact of the quality measures on providers, patients, the provider-patient relationship and what matters to patients. We define 5 attributes of quality measures we believe necessary to link the actions of providers and patients and lead to value for our health care system. "Fit for purpose" quality measures should focus health care delivery on value improvement and create a culture of value in our health care system.


Assuntos
Indicadores de Qualidade em Assistência à Saúde , Aquisição Baseada em Valor , Humanos , Estados Unidos
14.
Med Decis Making ; 42(1): 51-59, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34041964

RESUMO

Medicare's Hospital Value-Based Purchasing Program (HVBP) is the first national pay-for-performance program to combine measures of quality of care with a measure of episode spending. We estimated the implicit tradeoffs between mortality reduction and spending reduction. To earn points in HVBP, a hospital can either lower mortality or reduce spending, creating a tradeoff between the 2 measures. We analyzed the quality performance and earned points of 2814 hospitals using publicly available data. We then quantified the tradeoffs between spending and mortality in terms of quality-adjusted life-years (QALYs). If incentives in the program were balanced, then the tradeoff between spending and QALYs should be comparable with those of high-value health interventions, roughly $50,000 to $200,000 per QALY. Instead, the tradeoff in HVBP was about $1.2 million per QALY. HVBP overvalues improvements in quality of care relative to spending reductions. We propose 2 possible policy adjustments that could improve incentives for hospitals to deliver high-value care.


Assuntos
Reembolso de Incentivo , Aquisição Baseada em Valor , Idoso , Hospitais , Humanos , Medicare , Anos de Vida Ajustados por Qualidade de Vida , Estados Unidos
15.
Health Serv Manage Res ; 35(2): 66-73, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-33726545

RESUMO

OBJECTIVE: This study sought to understand the relationship of hospital performance with high-level electronic medical record (EMR) adoption, hospitalists staffing levels, and their potential interaction. MATERIALS AND METHODS: We evaluated 2,699 non-federal, general acute hospitals using 2016 data merged from four data sources. We performed ordinal logistic regression of hospitals' total performance score (TPS) on their EMR capability and hospitalists staffing level while controlling for other market- and individual-level characteristics. RESULTS: Hospitalists staffing level is shown to be positively correlated with TPS. High-level EMR adoption is associated with both short-term and long-term improvement on TPS. Large, urban, non-federal government hospitals, and academic medical centers tend to have lower TPS compared to their respective counterparts. Hospitals belonging to medium- or large-sized healthcare systems have lower TPS. Higher registered nurse (RN) staffing level is associated with higher TPS, while higher percentage of Medicare or Medicaid share of inpatient days is associated with lower TPS. DISCUSSION: Although the main effects of hospitalists staffing level and EMR capability are significant, their interaction is not, suggesting that hospitalists and EMR act through separate mechanisms to help hospitals achieve better performance. When hospitals are not able to invest on both simultaneously, given financial constraints, they can still reap the full benefits from each. CONCLUSION: Hospitalists staffing level and EMR capability are both positively correlated with hospitals' TPS, and they act independently to bolster hospital performance.


Assuntos
Médicos Hospitalares , Idoso , Registros Eletrônicos de Saúde , Humanos , Medicare , Estados Unidos , Aquisição Baseada em Valor , Recursos Humanos
17.
Med Care Res Rev ; 79(3): 414-427, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-34609233

RESUMO

Beginning in 2016, the Home Health Value-Based Purchasing (HHVBP) model incentivized U.S. Medicare-certified home health agencies (HHAs) in nine states to improve quality of patient care and patient experience. Here, we quantified HHVBP effects upon quality over time (2012-2018) by HHA ownership (i.e., for-profit vs. nonprofit) using a comparative interrupted time-series design. Our outcome measures were Care Quality and Patient Experience indices composed of 10 quality of patient care measures and five patient experience measures, respectively. Overall, 17.7% of HHAs participated in the HHVBP model of which 81.4% were for-profit ownership. Each year after implementation, HHVBP was associated with a 1.59 (p < .001) percentage point increase in the Care Quality index among for-profit HHAs and a 0.71 (p = .024) percentage point increase in the Patient Experience index among nonprofits. The differences of quality improvement under the HHVBP model by ownership indicate variations in HHA leadership responses to HHVBP.


Assuntos
Agências de Assistência Domiciliar , Serviços de Assistência Domiciliar , Idoso , Humanos , Medicare , Qualidade da Assistência à Saúde , Estados Unidos , Aquisição Baseada em Valor
18.
J Healthc Qual ; 44(2): 78-87, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34469925

RESUMO

BACKGROUND AND PURPOSE: The Medicare Value-Based Purchasing (VBP) program established performance-based financial incentives for hospitals. We hypothesized that total performance scores (TPS) would vary by hospital type. METHODS: Value-Based Purchasing reports were collected from 2015 to 2017 and merged with the Centers for Medicare and Medicaid Services (CMS) Impact File data. A total of 3,005 hospitals were grouped into physician-owned surgical hospitals (POSH), accountable care organizations (ACO), Kaiser, Vizient, and General hospitals. Longitudinal linear mixed-effects models compared temporal differences of TPS and secondary composite outcome, process, patient satisfaction, safety, and cost efficiency measures between hospital types. RESULTS: Total performance scores decreased across all hospital types (p < .001). Physician-owned surgical hospitals had the highest TPS (59.9), followed by Kaiser (49.2), ACO (36.7), General (34.8), and Vizient (30.7) (p < .001). Hospital types differed significantly in size, geography, mean case-mix index, Medicare patient discharges, percent Medicare days to inpatient days, Disproportionate Share Hospital payments, and uncompensated care per claim. Scores improved in 84% of POSH and 14.6% of Kaiser hospitals using score reallocations. CONCLUSION: In comparison with General hospitals, the TPS was higher for POSH and Kaiser and lower for Vizient in part due to weighting reallocation and individual domain scores. IMPLICATIONS: Centers for Medicare and Medicaid Services scoring system changes have not addressed the methodological biases favoring certain hospital types.


Assuntos
Organizações de Assistência Responsáveis , Aquisição Baseada em Valor , Idoso , Centers for Medicare and Medicaid Services, U.S. , Hospitais , Humanos , Medicare , Estados Unidos
19.
Rev. Esc. Enferm. USP ; 56: e20210333, 2022.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1376265

RESUMO

ABSTRACT The limited resources allocated to the health area and the growing demands require leaders' qualified and committed performance in hospital management. In this perspective, the objective of this study is to reflect on the management practices that can be applied to hospital facilities to achieve better care and financial results. Among them, process-based management proposes an approach for continuous process improvement to achieve desired results; the method Lean Six Sigma allows identifying and eliminating waste in production processes; the continuous improvement model combines practical knowledge with the knowledge of how the system to be improved works, through observations and changes that allow its results measurement; and cost management and value-based healthcare provides for care mapping, from beginning to end, to assess what actually adds value to patients. The contributions of implementing these practices are recognized worldwide; using them, processes can be increased, improving efficiency, reducing waste, adding value to the business, increasing its revenue, and resulting in savings that can be passed on to the consumer, by improving quality.


RESUMEN Los recursos limitados destinados al área de Salud y las crecientes demandas exigen la actuación calificada y comprometida de líderes en la gestión hospitalaria. En esta perspectiva, el objetivo es reflexionar sobre las prácticas de gestión que se pueden aplicar a las instituciones hospitalarias para lograr mejores resultados asistenciales y económicos. Entre ellos, la gestión basada en procesos propone un enfoque de mejora continua de procesos para lograr los resultados deseados; el método Lean Six Sigma permite identificar y eliminar los desperdicios en los procesos productivos; el modelo de mejoría continua combina el conocimiento práctico al conocimiento del funcionamiento del sistema que se reta mejorar, a través de observaciones y cambios que permitan la medición de sus resultados; y la gestión de costes y de salud atención médica basada en el valor establece que la atención sea mapeada, desde el principio hasta el final del proceso, para evaluar lo que efectivamente es lo que agrega valor a los pacientes. Las contribuciones de implementación de esas prácticas son reconocidas a nivel mundial; con ellas se pueden incrementar los procesos, aumentando la eficiencia, reduciendo los desperdicios, agregando valor al negocio, aumentando sus ingresos y generando ahorros que pueden transferirse al consumidor, al mejorar la calidad.


RESUMO Os recursos limitados destinados à área da Saúde e as demandas crescentes requerem a atuação qualificada e compromissada dos líderes na gestão hospitalar. Nesta perspectiva, objetiva-se refletir sobre as práticas de gestão passíveis de serem aplicadas às instituições hospitalares visando o alcance de melhores resultados assistenciais e financeiros. Dentre elas, a gestão baseada em processos propõe uma abordagem para melhoria contínua dos processos a fim de alcançar os resultados desejados; o método Lean Six Sigma permite identificar e eliminar desperdícios nos processos produtivos; o modelo de melhoria contínua alia o conhecimento prático ao conhecimento do funcionamento do sistema a ser melhorado, por meio de observações e mudanças que permitam a mensuração de seus resultados; e a gestão de custos e a Saúde baseada em valor preveem que o cuidado seja mapeado, do início ao fim do processo, para avaliar o que, de fato, agrega valor aos pacientes. As contribuições da implementação dessas práticas são reconhecidas mundialmente; utilizando-as, os processos podem ser incrementados, aumentando a eficiência, reduzindo os desperdícios, agregando valor ao negócio, aumentando a sua receita e resultando em economias que podem ser repassadas ao consumidor, pela melhoria da qualidade.


Assuntos
Gestão da Qualidade Total , Gestão em Saúde , Custos de Cuidados de Saúde , Aquisição Baseada em Valor , Administração Hospitalar
20.
Fam Pract Manag ; 28(6): 25-31, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34751544
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