Assignment 11: Facilities who treat Medicare patients

Assignment 11: Facilities who treat Medicare patients

The value-based purchasing is a system structured to reward hospitals and critical care facilities who treat Medicare patients. Hospitals must meet requirements and provide quality care in order to receive the incentives. I don’t feel that this system has been successful. For example, “Quality metrics have become needlessly redundant and burdensome for providers, with hundreds of different measurement systems, scoring algorithms, and certifications from a bevy of nonprofit registries, each with their own set of similar-yet-incompatible quality standards (Hutchinson, 2020). At my job, we limit the number of Medicaid and Medicare patients we accept for this very reason. Many times Medicaid and Medicare will oftentimes reject claims for various reason that cause lengthy delays in payments that are extremely frustrating. With hundreds of different measurement systems, scoring algorithms, and certifications from a variety of nonprofit registries, each with its own set of similar but incompatible quality standards, quality metrics have become redundant and hard for providers to keep track of (Hutchinson, 2020). Because of this, at my job, we limit the number of Medicaid and Medicare patients we can take. Medicaid and Medicare often deny claims for a number of different reasons, which causes long delays in payments that are very frustrating. We usually will submit claims sometimes three or more times before it is paid. This can affect the patient ability to be seen. They may get multiple letters and calls from our office about unpaid claims. Also, we will ask the patient to reach out to their Medicaid or Medicare caseworker. This many times is extremely helpful in facilitating the process because work hard to keep the patient in service with us due to limitation on acceptance.
References

Hospital Quality Institute. (2022). Value-based purchasing. https://www.hqinstitute.org/post/value-based-purchasing

Hutchinson, Kevin (2020). Is value-based care stalled?. https://www.gibson-consultants.com/2020/10/27/is-value-based-care-stalled/