Health care organizations such as Choice Hospital must keep up to date with new initiatives related to reimbursement by third-party payers for services provided. This is especially true for Medicare reimbursement and initiatives tied to legislation such as the Affordable Care Act and the 21st Century Cures Act.
You are working with the chief financial officer and his team on two types of statistics related to Medicare reimbursement initiatives:
- Medicare spending per beneficiary (MSPB)
- Hospital readmission rates
You will be working with the finance team to prepare a presentation for the CEO and executive leadership team to help them understand these requirements. Your presentation should be 5-7 slides (100-150 words per slide, not including the title and reference slides) with APA formatting. Cite at least 2 scholarly reference articles or government publications that were published within the last 3-5 years.Your presentation should address the following for both the MSPB and hospital readmission rate statistics:
- Describe the Medicare program or initiative that uses the statistic.
- Is it an incentive- or penalty-type program related to the rate of Medicare reimbursement?
- Are the statistics and the program or initiative tied to performance, for example improving quality of care? If so, how?
- Which legislation is authorizing the Centers for Medicare and Medicaid Services (CMS) to initiate these programs?
- Define the statistic and how it is calculated.
- Provide examples of these statistics from publications or government sites. For many of the CMS initiatives, data for health care institutions is made available through the CMS Hospital Compare Web site.
Expert Solution Preview
Introduction:
As a medical professor, it is crucial to understand the latest healthcare initiatives related to reimbursement by third-party payers to provide comprehensive education to future healthcare professionals. This assignment outlines the significance of two types of statistics – Medicare spending per beneficiary and Hospital readmission rates – in promoting quality care and its impact on Medicare reimbursement programs.
Answer:
Medicare spending per beneficiary (MSPB):
1. Describe the Medicare program or initiative that uses the statistic.
The Medicare program uses MSPB as a measure of hospital and physician costs associated with each beneficiary’s care.
2. Is it an incentive- or penalty-type program related to the rate of Medicare reimbursement?
It is neither an incentive nor penalty program. Still, it is utilized to determine the overall cost-effectiveness of an institution’s care and ensure efficient use of government funds.
3. Are the statistics and the program or initiative tied to performance, for example improving quality of care? If so, how?
Yes, MSPB is intended to encourage efficient and cost-effective healthcare services and, in turn, improve patient outcomes by ensuring hospitals and physicians use resources effectively.
4. Which legislation is authorizing the Centers for Medicare and Medicaid Services (CMS) to initiate these programs?
The Patient Protection and Affordable Care Act, commonly referred to as ACA, authorized the CMS to initiate MSPB.
5. Define the statistic and how it is calculated.
MSPB calculates the overall Medicare cost of each beneficiary’s care, including hospital and physician services, post-discharge care, and any potential readmissions within 30 days of discharge.
6. Provide examples of these statistics from publications or government sites.
According to CMS, the MSPB for 2020 was $10,223, indicating an increase of $141, or 1.4%, from the 2019 MSPB of $10,082.
Hospital readmission rates:
1. Describe the Medicare program or initiative that uses the statistic.
Hospital Readmission Reduction Program (HRRP) uses the statistic to measure the rate of unplanned hospital readmissions.
2. Is it an incentive- or penalty-type program related to the rate of Medicare reimbursement?
It is a penalty program in which the CMS reduces the reimbursements made to hospitals with excessive readmissions.
3. Are the statistics and the program or initiative tied to performance, for example improving quality of care? If so, how?
Yes, the initiative to reduce hospital readmission rates focuses on improving the quality of care provided to patients in hospitals, thereby reducing the chances of complications.
4. Which legislation is authorizing the Centers for Medicare and Medicaid Services (CMS) to initiate these programs?
The Affordable Care Act (ACA) authorized CMS to initiate HRRP.
5. Define the statistic and how it is calculated.
Hospital readmission rates refer to an unplanned readmission of a patient within 30 days of a previous hospitalization discharge due to complications related to the initial issue. CMS calculates them by comparing the number of expected readmissions based on the hospital’s history and demographics with the actual readmission numbers.
6. Provide examples of these statistics from publications or government sites.
As per the CMS Hospital Compare website, the national average readmission rates were 15.6% in 2016, which declined to 15.1% in 2019, indicating an improvement in quality of care.
