Reimbursement Strategies

Scenario:

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Medicare and private payers have expanded reimbursement under Accountable care organizations (ACO). You are the chief financial officer (CFO) of a hospital system that is forming an ACO to participate in these payment models. The ACO seeks to improve care coordination for its patients with chronic conditions. To provide better care management, the ACO is interested in investing in primary care physicians and physician’s assistants to provide more intensive care management services. After formation, the ACO will enter contracts with Medicare and private insurers under alternative payment models, including shared savings, bundled payments, and global capitation. The ACO will need to determine how to set up reimbursement payments to ACO providers and consider whether financial incentives are required to ensure ACO providers deliver efficient care.

 

The Assignment:

In a 2- to 3-page Word document that includes tables and/or calculations, make recommendations on the following: 1) number of physicians and nurse practitioners needed; 2) reimbursement method: salary or fee-for-service; 3) recommendations for financial incentives to address the challenges of supplier-induced demand and how to ensure efficiency. Interpret the net profit from the ACO contract based on your recommendations. Explain the rationale behind your recommendations, including the impact made by your financial calculations.

EXCELLENT – above expectations GOOD – met expectations FAIR – below expectations POOR – significantly below expectations or missing
Recommendations for 1) number of physicians and nurse practitioners; 2) reimbursement method: salary or fee-for-service; 3) recommendations for financial incentives to address challenges of supplier induced demand and ensure efficiency
Points:

Points Range: 9 (30%) – 10 (33.33%)

The recommendations are accurate and show depth and breadth in critical thinking when addressing the key points related to economic efficiency.

Feedback:

Points:

Points Range: 8 (26.67%) – 8 (26.67%)

The recommendations are accurate and fully address the key points related to economic efficiency.

Feedback:

Points:

Points Range: 7 (23.33%) – 7 (23.33%)

The recommendations are accurate and show depth and breadth in critical thinking when addressing the key points related to economic efficiency.

Feedback:

Points:

Points Range: 0 (0%) – 6 (20%)

The recommendations are accurate and fully address the key points related to economic efficiency.

Feedback:

Interpretation of the net profit from the ACO contract based on recommendations
Points:

Points Range: 8 (26.67%) – 8 (26.67%)

The interpretation shows critical thinking, considers divergent and competing opinions, and demonstrates creative problem solving in its analysis of the net profit from the ACO contract based on recommendations.

Feedback:

Points:

Points Range: 7 (23.33%) – 7 (23.33%)

The interpretation fully addresses the net profit from the ACO contract based on recommendations.

Feedback:

Points:

Points Range: 6 (20%) – 6 (20%)

The interpretation lacks depth or clarity in addressing the net profit from the ACO contract based on recommendations.

Feedback:

Points:

Points Range: 0 (0%) – 5 (16.67%)

The interpretation does not address (zero points) or poorly addresses net profit from the ACO contract based on recommendations.

Feedback:

Rationale, including how the financial calculations impacted your recommendations
Points:

Points Range: 7 (23.33%) – 7 (23.33%)

The rationale shows critical thinking, considers divergent and competing opinions, and demonstrates creative problem solving in its analysis of how the financial calculations impacted the recommendations.

Feedback:

Points:

Points Range: 6 (20%) – 6 (20%)

The rationale fully addresses how the financial calculations impacted the recommendations.

Feedback:

Points:

Points Range: 5 (16.67%) – 5 (16.67%)

The rationale lacks depth or clarity in addressing how the financial calculations impacted the recommendations.

Feedback:

Points:

Points Range: 0 (0%) – 4 (13.33%)

The rationale does not address (zero points) or poorly addresses how the financial calculations impacted the recommendations.

Feedback:

Writing
Points:

Points Range: 5 (16.67%) – 5 (16.67%)

The paper is well organized, uses scholarly tone, contains original writing and proper paraphrasing, follows APA style, contains very few or no writing and/or spelling errors, and is fully consistent with graduate-level writing style.

Feedback:

Points:

Points Range: 4 (13.33%) – 4 (13.33%)

The paper is mostly consistent with graduate-level writing style and may have some spelling, APA, and writing errors.

Feedback:

Points:

Points Range: 3 (10%) – 3 (10%)

The paper is somewhat consistent with graduate-level writing style and may have some spelling, APA, and writing errors.

Feedback:

Points:

Points Range: 0 (0%) – 2 (6.67%)

The paper is well below graduate-level writing style expectations for organization, scholarly tone, APA style, and writing, or shows heavy reliance on quoting.

Feedback:

Show Descriptions
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RECOMMENDATIONS FOR 1) NUMBER OF PHYSICIANS AND NURSE PRACTITIONERS; 2) REIMBURSEMENT METHOD: SALARY OR FEE-FOR-SERVICE; 3) RECOMMENDATIONS FOR FINANCIAL INCENTIVES TO ADDRESS CHALLENGES OF SUPPLIER INDUCED DEMAND AND ENSURE EFFICIENCY–
Levels of Achievement:
EXCELLENT – above expectations9 (30%) – 10 (33.33%)
The recommendations are accurate and show depth and breadth in critical thinking when addressing the key points related to economic efficiency.

GOOD – met expectations8 (26.67%) – 8 (26.67%)

The recommendations are accurate and fully address the key points related to economic efficiency.

FAIR – below expectations7 (23.33%) – 7 (23.33%)

The recommendations are accurate and show depth and breadth in critical thinking when addressing the key points related to economic efficiency.

POOR – significantly below expectations or missing0 (0%) – 6 (20%)

The recommendations are accurate and fully address the key points related to economic efficiency.

Feedback:

INTERPRETATION OF THE NET PROFIT FROM THE ACO CONTRACT BASED ON RECOMMENDATIONS–
Levels of Achievement:
EXCELLENT – above expectations8 (26.67%) – 8 (26.67%)
The interpretation shows critical thinking, considers divergent and competing opinions, and demonstrates creative problem solving in its analysis of the net profit from the ACO contract based on recommendations.

GOOD – met expectations7 (23.33%) – 7 (23.33%)

The interpretation fully addresses the net profit from the ACO contract based on recommendations.

FAIR – below expectations6 (20%) – 6 (20%)

The interpretation lacks depth or clarity in addressing the net profit from the ACO contract based on recommendations.

POOR – significantly below expectations or missing0 (0%) – 5 (16.67%)

The interpretation does not address (zero points) or poorly addresses net profit from the ACO contract based on recommendations.

Feedback:

RATIONALE, INCLUDING HOW THE FINANCIAL CALCULATIONS IMPACTED YOUR RECOMMENDATIONS–
Levels of Achievement:
EXCELLENT – above expectations7 (23.33%) – 7 (23.33%)
The rationale shows critical thinking, considers divergent and competing opinions, and demonstrates creative problem solving in its analysis of how the financial calculations impacted the recommendations.

GOOD – met expectations6 (20%) – 6 (20%)

The rationale fully addresses how the financial calculations impacted the recommendations.

FAIR – below expectations5 (16.67%) – 5 (16.67%)

The rationale lacks depth or clarity in addressing how the financial calculations impacted the recommendations.

POOR – significantly below expectations or missing0 (0%) – 4 (13.33%)

The rationale does not address (zero points) or poorly addresses how the financial calculations impacted the recommendations.

Feedback:

WRITING–
Levels of Achievement:
EXCELLENT – above expectations5 (16.67%) – 5 (16.67%)
The paper is well organized, uses scholarly tone, contains original writing and proper paraphrasing, follows APA style, contains very few or no writing and/or spelling errors, and is fully consistent with graduate-level writing style.

GOOD – met expectations4 (13.33%) – 4 (13.33%)

The paper is mostly consistent with graduate-level writing style and may have some spelling, APA, and writing errors.

FAIR – below expectations3 (10%) – 3 (10%)