Consider what you’ve learned so far about the transition from volume- to value-based reimbursement....

Question

Consider what you’ve learned so far about the transition from volume- to value-based reimbursement. Different organizations will respond to the impact of this change in various ways. Based on its actions, an organization may flourish, or it may fail as its reimbursement decreases. As reimbursement methodology changes, institutions must adapt.

To prepare for this Assignment:

Read Case 5: Middleboro Community Hospital in this week’s Learning Resources, and consider the actions taken by this organization. Review data tables regarding their case mix (top DRGs), Patient Days, and CMS Core Measures. These metrics address both qualitative and quantitative measures in this organization.

The Assignment:

Write a brief, 2-page executive summary of the impact of the transition from volume-based to value-based health care. Specifically, address how this change in reimbursement methodology impacts operational requirements and how it can be implemented. Recommend at least two adjustments to operations which may position the organization for success under value-based health care.

Robert · Accepted Answer

Impact of the Transition from Volume-Based to Value-Based Healthcare 
1 INTRODUCTION 
This paper aims to elucidate the impact of value based reimbursements as compared to volume based 
reimbursements in the healthcare sector in USA. In 2015, the Government sensibly publicized that 30% of Medicare 
disbursements would go in the direction of different payment models by end of 2016. By 2018, 90% of all Medicare 
disbursements will be secured to excellence or value – including 50% via alternative payment models.  The policy 
issue of financing in health care pertains to the reimbursement to providers from the Medicaid and Medicare. The 
payments have been insufficient to carry on the quality care and support service. The independent providers also 
contend that the level of reimbursements should be increased but the insurance providers have been concerned about 
the rising cost of long term care while the taxes have not been increased which mainly finance these insurance costs. 
The coverage for the nursing home care from private long term care insurance has increased slightly in recent years.

Consider what you’ve learned so far about the transition from volume- to value-based reimbursement. Different organizations will respond to the impact of this change in various ways. Based on its...

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