The implementation of additional quality metrics, and these changes impact reimbursement rates

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Read the scenario that you will use for the Individual Projects in each week of the course. The Centers for Medicare and Medicaid Services (CMS) has taken on a more visible role in health care delivery. Many changes have transpired to improve patient safety along with the implementation of additional quality metrics, and these changes impact reimbursement rates.

Likewise, the Patient Protection and Affordable Care Act has changed the reimbursement fee structure of Medicare and Medicaid reimbursement for health care services. Other legislation including the HITECH Act and the Medicare Authorization and CHIP Reactivation Act of 2015 (MACRA) all impact how healthcare organizations receive reimbursement and demonstrate use of data to improve quality and delivery of patient care.

Scenario

Mr. Magone, CEO of Healing Hands Hospital, has asked you to join the “Future of Healing Hands” Task Force. Your first assignment is to work with the Hospital Chief Financial Officer, Mr. Johnson, and provide a summary of the current regulations regarding Medicare reimbursement including how MACRA will impact reimbursement if/when Healing Hands coordinates delivery of services by affiliating with physician practices.  
 

For this assignment, write a 2-page report, not including the title page and reference page, on how the new CMS initiatives and regulations will impact the organization’s revenue structure. The HCM Learning Center page for this class has excellent resources for more information within the Unit 1 tab. This is Section 1 of your report to the Task Force. This first section should be titled “Impact of CMS Regulations and Reimbursement Models”. In your report include:

  • How does CMS impact the reimbursement model for Healing Hands Hospital and other health care organizations? If CMS reimbursement regulations for Medicare and Medicaid change, does it follow that other insurance providers change their policies on reimbursement? 
  • The CMS website on Innovation Models provides examples of healthcare payment and service delivery models designed to increase quality of care while reducing costs. 
    • Choose one example of ongoing or planned models for Accountable Care Organizations or Episode-Based Payment Initiatives and explain how participation in the models would be beneficial to Healing Hands Hospital. 

Be sure to include at least two reference sources and cite them using APA formatting.