Models of payment to healthcare organizations have begun to shift from paying for volume (fee for service) to paying for value (quality). Using a Venn Diagram, compare volume-based versus value-based reimbursement. Use the editable template for the Venn Diagram, which is available for download on the Course Resources page. This template (with your findings) will need to be posted as an attachment in your discussion post along with your written prompt.
Consider Jim, who is 69 years old and comes to your Emergency Department (ED) with severe abdominal pain. His evaluation, besides a physical exam, includes an abdominal ultrasound, a CT scan with and without contrast, multiple lab studies, all lead to his having an emergency appendectomy. Other than having Type II diabetes well controlled on diet and exercise, he is in otherwise good health. Jim is treated as an outpatient and is discharged home the next morning. Two weeks later he returns to the ED with fever, continued abdominal pain, and a surgical site infection. He is admitted and is treated for 5 days before being sent home.
Using your findings from your comparison of volume- versus value-based reimbursements, analyze the scenario. Determine how the hospital could charge and be reimbursed using the two methods. In this case, which would be better for the hospital? How do each of these payment models contribute to or detract from the goal of the Triple Aim? Considering payer mix, delivery systems, population demographic, and value-based purchasing of the institution. How do all of these elements influence the financing of the type and quality of care provided at your facility? What are the implications on access and availability of types of care provided by your institution?
Remember to support your thoughts with scholarly sources.
Solution:
In regards volume based reimbursement, the healthcare could request for reimbursements for all the consultations, diagnostic tests, treatments and medications provided. In as much as the healthcare would seem to gain more in terms of financial reimbursements, it has lost a lot in providing quality care, minimizing costs and providing access to more patients (Henkel & Maryland, 2015). This is because, the patient would have been treated with evidence-based interventions the first time he visited the healthcare. The multiple lab tests are highly costly and unnecessary. Further, the time spend on him could have been spend on other patients if at first he received productive treatment services. In considering value-based reimbursement, the healthcare can be reimbursed based on the quality of care provided. It would be very advantageous if the patient revisits with same ailments are reduced as they are indicators of poor…..Please click the Paypal icon below to purchase full solution for only $5