Running head: ORGANIZATIONAL LEADERSHIP1Organizational Leadership and Interprofessional Team DevelopmentPatricia RhinevaultWestern Governors University
ORGANIZATIONAL LEADERSHIP 2Business PracticesHealth care is a business and must meet specific guidelines for reimbursement from the Centers for Medicare and Medicaid (CMS) and private insurance companies. Private pay patients make up a smallamount of revenue for a hospital. Private insurance companies provide their patients with lists of physicians or hospitals where they must be seen in order to have their care paid for by the company. The delivery of health care, especially with the advent of the Affordable Care Act, requires that healthcare organizations are accountable for the care provided at various levels of service, from outpatient to acute care to home care (Rousell, et al., 2011). Reimbursement is also affected if the hospital doesn’t follow the regulatory requirements set by agencies. For instance, The Joint Commission (2019) has a list of national patient safety goals. Examples of these goals are improving the accuracy of patient identification, reduce the risk of health-care associated infections and improve the safety of clinical alarm systems. The purpose of these goals is to improve patient safety. Accreditation by JCAHO shows a commitment to high quality patient care. In some cases, liability insurance for the hospital costs less if the hospital is accredited. Losing this accreditation translates into loss of reimbursement by CMS and private insurance companies. Accredited hospitals have also been shown to attract higher caliber nurses and provide better opportunities for staff development. Value-based purchasing (VBP) describes a broad set of performance-based payment strategies that align financial incentives to providers’ performance on a set of prescribed indicators (Rousell, Harris, Thomas 2011). If certain guidelines are not met, reimbursement goes down or is not paid at all. The CMS developed this reimbursement plan in order to promote the best practice for patient care and to give hospitals incentives to do “better” than other hospitals. Hospitals that do patient care well are reimbursed more than hospitals that perform poorly. Driven by the Institute of Medicine report To Err Is Human: Building a Safer Health System, which outlined the cost of poor quality in the form of medical errors, hospital-acquired infections, and medical errors resulting in patient harm, CMS and other payers are
ORGANIZATIONAL LEADERSHIP 3focusing on improving patient safety and outcomes. They are making improvements through financial penalties for lack of participation or poor performance compared with peer hospitals (Rousell, et al., 2011). Patient satisfaction scores are playing a larger and larger part of hospital reimbursement. In addition to clinical outcomes, the patient experience was added in 2013 to incorporate elements of patient satisfaction, healthcare team member communication, discharge information, and pain management (Rousell, et al., 2011).
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