An “Accountability in Healthcare Essay” is an academic essay that explores the concept of accountability in healthcare. The essay may cover a range of topics related to accountability in healthcare, such as the responsibilities of healthcare providers, the role of patients in their own care, and the accountability of healthcare systems and institutions. The essay may examine the different ways in which accountability can be defined and measured in healthcare, as well as the challenges and barriers to achieving accountability in the healthcare system. It may also discuss the ethical and legal implications of accountability in healthcare, including the potential consequences for healthcare providers and patients.
Accountability in health care
Accountability in healthcare refers to the responsibility and obligation of healthcare providers, organizations, and systems to deliver quality care to patients, use resources efficiently, and be accountable to patients, stakeholders, and the public for their actions and decisions. This includes maintaining ethical standards, following relevant laws and regulations, and transparently reporting and improving performance. Healthcare is a complex and multifaceted concept that requires the involvement of all stakeholders, including healthcare providers, organizations, patients, and governments. For instance, patients promote accountability by participating in their own care, reporting issues and concerns, and providing feedback. Through the cooperation of healthcare providers, organizations, patients, and the government to promote transparency and accountability, we can improve the quality of care and ensure that the healthcare system serves the needs of all patients.
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Accountable care organization
An accountable care healthcare organization is a health organization or group of doctors or hospitals that tie provider reimbursement and coordinate efficient, high-quality, low-cost patient care as they share the incurred financial responsibilities. These systems have aligned financial incentives, electronic health records, resources, and team-based care and support cost-effective care for all patients. Often ACO agrees to coordinate care for individuals and deliver care at the right time and in the right way, as they avoid unnecessary utilization of services and any other medical errors (Wilson et al., 2020). It has a sustainable impact on healthcare providers as it is essential to improve population health management and patient outcome. Improving health care management can help healthcare providers ensure that patients are prevented from disease and promote their wellness since they will not be overwhelmed with work. The providers are also bound to share cost savings and heavily benefit from these population management approaches encouraged by accountable care organizations.
Differences between ACOs and HMOs
A health maintenance organization (HMO) is an insurance structure that provides coverage to patients for a monthly or annual fee through a network of physicians. Often, it is made up of a group of medical insurance providers that limit coverage to medical care. HMO allows for a lower premium since providers have the advantage of patients directed to them. The conceptual and structural differences between HMOs and ACOs are that ACOs mainly consists of clinicians, organizations, or hospital groups that contract with insurers (Wilson et al., 2020), while HMOs are the groups that provide insurance and contract with clinicians. ACOs are purposed to leverage better and more efficient health care practices to benefit the patient and cut the cost in the long run, while HMOs are purposed to fix the price of health care. Unlike HMOs, ACOs do not make the arbitrary cut, as they are designed to work by providing overhead, providing better healthcare, and increasing opportunities for patients. There is involuntary participation in HMOs, while for ACOs, patients choose to participate and often do not require permission or referrals to switch medical practitioners. Providers also choose to be the system providers and get additional payment by demonstrating their efficiency. Finally, HMOs actively control medical prices, while ACOs restrict payments with the hope of creating a system that is better than the resources it provides.
Health information technology
Health information technology is health information; specifically information technology used in health care to support information management across systems and ensure a confidential means of exchanging health information with the facility. HIT plays the role of supporting data collection, analysis, and data exchange. It can also support accountable health care, including sharing information between and among clinicians and integrating data from various sources (Dhillon, 2021). HIT can help in the early detection of health problems. It can integrate data collation from tests instantly, monitor the patient’s condition, and give healthcare practitioners feedback in real time. In its monitoring and evaluation, HIT also provides alert and early warning capabilities that can help improve customer outcomes. Since the health care industry is evolving first, integrating health information technology can help improve well-informed decision-making and keep records secure without depending on on-paper memory. This ensures that medical processes are swift. HIT also makes it easier for the medical profession, administrators, and patients, as it helps to engage the needs of first service delivery and proper health care.
Benefits of partnering with primary care
Primary care is often the first point of contact between the patient and the healthcare system. It provides patients with information and resources for maximum health outcomes. The primary aim of primary health is to improve the health of individuals as it provides easy access to medical care. When hospitals partner with primary care, it facilitate their care for the population and creates an integrated care network that will keep patients healthier and support specialized service lines. Hospitals can also be in a better position to manage acute episodes, well known to the primary care providers, when they can build on the medical and social history of the patient. Hospitals can coordinate with primary care to provide high-quality health care while reducing the cost and preventable re-hospitalization. Partnering with primary can limit competition with the hospital, build loyalty to the facility and assist with the recruitment and retention of primary care providers. Primary health care can also help hospitals build goodwill within the hospital and the community. This goodwill can help in building trust and keeping patients satisfied.
The bundled payment provides a single comprehensive payment that often covers all the services in a given patient care period. It has a predominantly positive effect on medical spending and health care quality. Under this payment system, healthcare providers and hospitals are reimbursed with one payment for the entire care episode, increasing the transparency and predictability of costs for patients and payers. Usually, the payment programs vary, but providers get to keep the savings if the episode costs less than the expected budget. In some instances, they may be responsible for the extra cost if the budget exceeds the payment. These payments can contain the health care cost by capitalizing on the provider entity’s need to manage a budget and ensure quality. The bundled-payment model also has a closer partnership with providers; this helps coordinate health care services, reducing the low-value care service and overuse of care. This can help contain the cost. The bundled payments are also initiated involuntary basis, which can lead to the selection, ensuring that a patient is provided with only the services they need; this ensures that they do not spend unnecessarily on what they need not. However, implementing bundling payment for a more complex health condition could reduce patient access to quality health care.
Pay for performance
These are initiatives to improve efficiency, equality, and general health care outcomes. They often provide financial incentives to hospitals and healthcare providers to carry out improvements and achieve the best patient outcome. Through this financial incentive to the practitioner, pay for performance attempts to improve adherence to best practices; through these adherences, t clinical guidelines, quality, and health care outcomes are improved. It nudges privates towards value-based care since it ties reimbursement to merit-driven outcomes, patient satisfaction, and proven best practices, which are the essential elements of wealthy health care. This program entitles hospitals to pay attention to a broad ray of factors that are addressed in health care. Under the program, hospitals can also be penalized financially for sub performance, making practitioners work at their best to avoid these penalties. These initiatives also create market competition by establishing high and low performers. Competition within the healthcare system is essential as it can encourage institutions to provide the best healthcare surveys to retain their patients; there always be an option for care.
These are incentive programs created by centers of Medicare as ways of rewarding hospitals which provide high-quality care to Medicare beneficiaries. The programs often adjust payment to such hospitals under an inpatient prospective payment system based on quality health care delivery. VBP is designed to provide quality care and ensure patients have better experiences. Hospitals are often encouraged to improve their quality, efficiency, and patent care to receive incentives from these programs (Chee et al., 2016). The program withholds participating hospital Medicare payment by a law-specified percentage, uses the estimated total amount of these reductions to fund the payment according to their performance, and applies the net result and the incentives as claim by claim adjustment. Since VBP is budget neutral, the entire 2% reduction must be paid back to participating hospitals; this makes the highest performing hospitals earn back boniness greater than the payment reduction affecting the hospital’s reimbursement. However, other hospitals may receive minimal payment increases or no payments.
Who benefits from value-based reimbursement?
Since hospitals are rewarded for providing better services and patient experiences, patients benefit more than others. They will be the biggest beneficiaries since they will receive the best care. The primary goal of value-based reimbursement is to deliver value to the patients. This means healthcare focuses on the outcome that matters most to the patient, and care is alighted on how patients experience health. Also, healthcare outcomes are isolated to one area and across the full spectrum of comorbidities and side effects that may accompany the illness. The patient also benefits since it encourages healthcare systems to solve patient needs rather than only treating them for illnesses. It also provides health care practices to patients at a potentially lowers cost; it is believed that value-based reimbursement is critical in health care to control the rising cost of health care.
How VBP programs measure hospital performance
Since the ultimate objective of VBP is always to uphold providers’ accountability through financial incentives, the first measure VBP programs use to measure health performance is to gauge healthcare performance. The program measures hospital performance through appropriateness criteria measure. It is also important to incentivize and help providers build quality improvement infrastructure; enhancing electronic health records’ ability can help support measurement. Hospitals are also gauged on measures such as mortality and complication, healthcare-associated infection, patient safety, patient experience, and efficiency in cost reduction. However, each hospital may only earn two scores from the measures. This means that part of the hospital’s Medicare adjustments can be based on the performance score that is reflected on the measured basis. That is, how well the hospital performs compared to all the other hospitals or how much they have improved or is ready to improve its performance compared to its initial performance during a prior assessment.
Chee, T. T., Ryan, A. M., Wasfy, J. H., & Borden, W. B. (2016). Current state of value-based purchasing programs. Circulation, 133(22), 2197-2205. https://doi.org/10.1161/circulationaha.115.010268
Dhillon, J. S. (2021). Role of Information Systems in Healthcare. Health Science Journal, 15(7), 125.
Wilson, M., Guta, A., Waddell, K., Lavis, J., Reid, R., & Evans, C. (2020). The impacts of accountable care organizations on patient experience, health outcomes and costs: A rapid review. Journal of Health Services Research & Policy, 25(2), 130-138. https://doi.org/10.1177/1355819620913141