In general, the term accountability stands for taking responsibility for one’s actions and accepting any mistakes or failures. Professionals have to be able to stand for their decisions, explain reasoning for engaging in specific activities, and handle criticism appropriately. Talking about the healthcare industry, accountability is especially significant. In case there is a lack of this specific concept in an organization, the quality of care decreases, patients become less satisfied with the treatment they receive, and the overall reputation of the facility may be ruined. The absence of accountability can even put the life of patients at risk. Therefore, it is vital to research this topic more and educate professionals about the importance of accountability and delivery of quality treatment in the healthcare industry. The following paper will discuss the specified concept in more detail by mentioning some characteristics and processes connected to it.
Accountability Care Organization: Definition, Comparison, and Strategies
Accountable Care Organizations, also referred to as ACOs, are an important addition to the healthcare field since they play an essential role in payment transformation. LaPointe (2019) mentioned that ACOs are associations of hospitals and other providers who aim at coordinating care for patients and delivering appropriate treatments, “while avoiding unnecessary utilization of services and medical errors” (para. 2). It is common for ACO participants to take responsibility and cover total costs of care for sick individuals (LaPointe, 2019). It is believed that coordination and performance through Accountable Care Organizations is a critical step towards managing the problems connected to the quality of healthcare. For instance, ACOs have the power to contribute to fixing the ineffective fee-for-service system which is a model where services are paid for separately (LaPointe, 2019). This method allows doctors to gain financial benefits by proving quantity rather than quality, influencing their patients’ well-being in a negative way. Therefore, ACO are groups of healthcare facilities or specialists that can help the medical industry to manage problems and positively impact the quality of its operations.
Health Maintenance Organization is another popular development that exists in the field of healthcare. HMO is a structure that provides health insurance coverage for a specific fee (Hayes, 2020). These organizations secure their network of care providers by being in constant and official contracts with primary care physicians, various specialists, and different types of healthcare facilities (Hayes, 2020). Thus, it can be stated that the main difference between an ACO and HMO is that the second organization is an insurance company while the first is not. The second distinctive feature is that HMO is a considerably structured entity with a number of regulations and restrictions. At the same time, an Accountable Care Organization gives its customers an opportunity to move within its framework. In addition, while ACOs are focused on the quality of care, HMOs have measurable standards to determine an appropriate quality control (Hayes, 2020). Consequently, there are three main distinctives between ACOs and HMOs.
Health Information Technology is one of the most used concepts in the contemporary model of medicine. HIT refers to the application of data processing which involves computer software and hardware that manage storage, sharing, collection, retrieval and use of any healthcare information and communication (Sharma et al., 2016). This concept uses both simple and complex technologies which help to reduce the number of human errors, improve treatments outcomes, facilitate the coordination of care, and track necessary data (Sharma et al., 2016). However, the main role of Health Information Technology is to ensure secure and private exchange of information between clients, patients, healthcare providers, and medical facilities (Sharma et al., 2016). For this reason, it can be stated that a professional implementation of Health Information Technology is an essential process in the modern medical field.
Primary Care Providers and Effective Payment Strategies
In recent years, partnering with primary care providers became a widely used strategy among healthcare establishments. These doctors are usually experienced individuals who act as a primary contact for people in case they suspect a certain medical condition or are in a situation of medical emergency (Hayes, 2020). It is important to mention that the existence of a first point of reference means that a person cannot receive care from a medical facility or a specialist without getting a referral form their PCP (Hayes, 2020). Since primary care physicals are informed about their patients’ health histories, lifestyles, and risk, they help other professionals to make quicker and more appropriate medical decisions in case of a disease. Moreover, their ability to be in constant contact with individuals encourages early health interventions and more effective treatments which is beneficial for both patients and hospitals.
Bundled payments are one of the ways the contemporary healthcare industry tries to bring advancements to the payments system and move towards care based on value. This type of payments is also known as episode payment models which “require participant providers to assume risk, as they must cover costs that go above the target price for an episode of care” (“What are bundled payments?” 2018, para. 2). On the other hand, healthcare providers share the savings in case they keep costs that are below the price while also ensuring that they will maintain quality requirements and standards (“What are bundled payments?” 2018). Therefore, by using bundling payments it is possible to bring the costs down as well as show an improvement in care quality.
Pay for Performance is another essential part of the overall strategy that moves healthcare towards a value-based approach and has potential to improve quality care. It is believed that most P4P programs and strategies provide an advantage of rewarding professionals for their medical actions and achievements which encourages them to work with complex and seriously ill patients (Haynes, 2020). Thus, this is the way Pay for Performance improves quality care – doctors feel more motivated to work and achieve positive results, and patients receive the most effective treatments. Even though there are claims that P4P is detrimental because specialists can misuse financial benefits, this strategy has a positive effect on the satisfaction of patients with care delivered to them by medical facilities.
Value-Based Purchasing Program
In short, value-based purchasing programs are created in order to link provider payments to better performance of care providers. As mentioned by Ramirez et al. (2016), “hospital Value-Based Purchasing Programs measure value of care provided by participating Medicare hospitals and creates financial incentives for quality improvement and fosters increased transparency” (p. 559). These programs act as a part of a larger strategy aiming to reform the healthcare industry and change the way it is delivered and paid for (Ramirez et al., 2016). Doctors and other professionals are rewarded with incentive payments based on the level of their performance and care they deliver to the patients (Ramirez et al., 2016). In case value-based programs’ techniques are implemented appropriately, the medical field will finally be able to move from providing quantity to delivering quality.
Value-Based Purchasing Programs are an important step towards providing high quality healthcare through financial incentives and affecting the model of reimbursement to hospitals. Nevertheless, the only question is how Value-Based Purchasing Programs influence the process of reimbursement. Since the concept states that healthcare should be founded on the quality of care provided and the satisfaction of patients and their families, the reimbursement is also based on the outcomes rather than the amount. For this reason, it can be concluded that Value-Based Purchasing Programs positively influence the reimbursement to hospitals. With the new model of delivering care, reimbursement is no longer connected to the already discussed fee-for-service model. Therefore, people receive quality care and hospitals achieve financial benefits for effective work rather than the number of treatments.
Reimbursement based on value is definitely a benefit for both healthcare facilities and patients. While hospitals attain high reputation for providing efficient treatment programs and charging sick individuals fairly, people receive whatever they pay for and have a possibility to manage their health problem properly. However, the benefit of value-based reimbursement for the patients seem to be more significant. From the beginning of their treatment, people can be sure that they will be assisted by the most experiences professionals who will deliver high quality care and support to them. They do not have to worry about losing their time while treating symptoms and slowly moving towards finding the root of the problem. Instead, by engaging in value-based reimbursement, patients can be sure that doctors will be interested in diagnosing them as early as possible. Therefore, value-based reimbursement carries some important advantages for all agents participating in healthcare and, especially, patients.
As mentioned earlier, the main goal of Value-Based Purchasing Programs is to move from quantity to quality. The healthcare industry has to focus on delivering high quality care instead of achieving unnecessary numbers. Furthermore, the interest of the patients has to be a priority because if they are satisfied it is much easier for a specific medical institution to develop and achieve a high reputation. Thus, by establishing this goal, Value-Based Purchasing Programs also creates a way to measure the performance of doctors and hospitals. By using various techniques, these models can evaluate whether the objectives were achieved, patients were satisfied, and the care delivers was effective and appropriate. Hence, VBP measures hospitals’ performance by analyzing the processes happening there and the outcomes of those procedures both for the patients and the institution.
Conclusion
Overall, healthcare industry is a complex sophisticated field that constantly goes through advancements and developments. One of the most important concepts to consider in the contemporary medical environmental is accountability that also touches other approaches, such as ACO, HMO, HIT, PCP, P4P, bundled payments, and value-based purchasing programs. After completing this paper, it can be stated, that the main goal of modern hospitals should be to provide high-quality care and forget about the number of treatments provided. In case medical institutions focus on quality, it will be easier for them to achieve certain objectives and satisfy their patients. Thus, the presented essay discussed accountability in healthcare industry and various concept connected to this topic.
References
Hayes, A. (2020). Health Maintenance Organization (HMO). Investopedia. Web.
LaPointe, J. (2019). Understanding the fundamentals of Accountable Care Organizations. RevCycleIntelligence. Web.
Ramirez, A. G., Tracci, M. C., Stukenborg, G. J., Turrentine, F. E., Kozower, B. D., & Jones, R. S. (2016). Physician-owned surgical hospitals outperform other hospitals in medicare value-based purchasing program.Journal of the American College of Surgeons, 223(4), 559-567. Web.
Sharma, L., Chandrasekaran, A., Boyer, K. K., & McDermott, C. M. (2016). The impact of health information technology bundles on hospital performance: An econometric study.Journal of Operations Management, 41, 25-41. Web.
What are bundled payments?(2018). Web.