Course  

NR 533 Financial Management In Healthcare Organizations

Volume-Based Versus Value-Based Reimbursement

Instructions 

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. Be sure the overlapping area contains the commonalities between the two systems. Use the editable template for the Venn Diagram, which is available for download above. 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?

ANSWER 

The quality of care for Jim with volume-based reimbursement could have been diminished. There was no reason to have multiple tests done to determine that he needed his appendix removed, a CT scan would have been sufficient in diagnosing appendicitis. They also did not consider that with his diabetes that there could be post-operative complications such as infection. The reason for the rushed discharge could easily have been so they could admit another patient into his bed, the patient turnover could be the way to increase revenue to the facility. Due to Jim having to return to the hospital and be admitted for a post op infection the insurance is now being billed for the same condition….please click the purchase button below to access entire answer at $5