Value Based PurchasingIntroduction
2007 is considered to be a very important year in the medical field for both medical institutions and patients. This is a time when these Centers that provide both Medicare and Medicaid services (C.M.S) embarked on initiating a program that would ensure higher quality practices in the field (Dlugacz, 2009). The program was dubbed the value-based purchasing program (Dlugacz, 2009). This program was initiated I a bid to directly connect the efforts made by both Medicare and Medicaid facilities towards ensuring quality care for their patients.
In order to measure and also achieve the higher quality expected, the value-based purchasing program was divided into three elements that were to be scrutinized independently. They include; the quality of experiences that patients had while at the centers, whether they did or did not acquire and hospital acquired conditions and lastly, the centers were judged on their ability to be able to treat the specified diagnosis as required of them (Dlugacz, 2009).
With the three elements of value based purchasing program stated above, this paper is going to concentrate on some of the important aspects of the program that a considered vital. In that regards, in order to avoid generalization, this paper is going to tackle a specific hospital-acquired condition hence focusing on Pressure Ulcers. It is also going to highlight important legal implications that both patients and health centers are expected to be aware of. Before finalizing on the outcomes that were discovered, a section regarding the accrediting bodies relating to the value-based purchasing program will be discussed and some of their expectations highlighted.
Hospital -Acquired Condition Defined
Hospital –Acquired Conditions are can be defined as specific occurrences/ predicaments that patients rarely find themselves in and can be prevented, but it some instances, still occurs (Charney, 2012). In order to have a clear picture of the rate at which specific hospitals have these acquired conditions, the accreditation bodies are known to study specific Medicare patients who visit whenever they visit the health centers in question. It is of utmost importance to note that hospital today, more than ever are always very keen when it comes to scrutinizing a patient’s health condition before they undergo and medical procedure at the centers (Stephen L. Isaacs, 2009). The main motivation behind this is the fact that a hospital would not be liable for a patient’s condition, prior to the hospital visit. On the other hand, the hospital would be obligated to cater and pay for the expenses that might arise as a result of a patient falling victim to a hospital-acquired condition. Some of the conditions that have recently been categorized as Hospital –Acquired Condition include incidences of; blood incompatibility, falls and trauma experienced during the stay in the medical facility, a clear manifestation of poor glycemic control foreign object retention after surgery and even stage three and four pressure ulcers (Houser, 2011).
Pressure Ulcers
Pressure ulcers it typically a condition that arise as a result of a patient applying pressure to a specific part of the skin for a long period of time. In some cases, this varies in that pressure ulcers come about faster in high pressure in stances over a short period of time of low pressure over a relatively long period of time. In the long run, the pressure exerted penetrates the skin tissue and go deeper into the soft tissue, and even the muscles that surround the area. By the time the whole process gets to the bone and cell death is evident, ulceration is always clearly evident.
The Four Stages of Pressure Ulcer Development
This categorization of pressure ulcer stages comes about as result of looking at the severity of the wound. In the first stage of ulceration, the region around where pressure has been exerted for a prolonged period of time is known to notably turn red (Barbara Haag-Heitman, 2010). On or the early signs of the formation of a wound is when the area is pressed, it fails to change white. Medics have stated this as the first sign of the development of a pressure ulcer. In the second stage, the same region graduates from just not turning white when pressed to an open sore. The region visibly looks irritated and blistered (Stephen L. Isaacs, 2009).
According to the Hospital –Acquired Conditions, the most critical stages of pressure ulcer include the next two final stages. In the third stage, as a result of extensive damage caused by the application of pressure to the skin, a crater is formed. The presence of a visible opening and skin tissue damage is also obvious (Houser, 2011). The fourth stage entails the area damage progressing further to reach not only the soft tissues but include the muscles, and even the bones. In some instances, the damage is always too extensive to a point where it gets to tendons and even joints.Are Pressure Ulcers Preventable?
Pressure ulcers are known to be preventable is enough preventive measure are taken. Looking at the fact that more than two thirds of patients who fall victims to pressure ulcers while in medical institution are always above the age bracket of 70 years and above, more attention can be given to them. The other categories of patients who are considered high risk are those who have been rendered immobile. With this in mind, fact is that they are exposed to long periods of time with no movement. This is a clear recipe for developing pressure ulcer being that pressure is exerted in on are for a prolonged period of time, especially in around bony areas.
In order to prevent instances of patients developing pressure ulcers, more care is always expected to be given to patient with comorid medical conditions. This category of patients is known to have reduced capability of quick recovery from wound developed. Diabetic patients are included in this section.
Pressure ulcers as a condition is very much preventable and there are outlined procedures that can be followed in order to reduce further progression. Some of these measures include constant relief on pressure in regions that are prone to develop pressure ulcers. This can be achieved by simple measures like the addition of extra pillows in a timely manner. In case the ulceration is still in the initial stages, it is vital to handle it according to the doctor’s instructions. With the current advancement in the medical field, not only can pressure ulcers be reversed by regular rinsing of the region with warm salty water, but also application of new medical creams that work toward faster recovery
In order to prevent pressure ulcers, patients who are on bed rest and are unable to move as a result of their medical condition are always advised to have available someone who can take care of them by repositioning them after every two hours. In order to make the care more thorough, a full body check is always considered vital, on top of more care being given to regions that show signs of reddening. Good eating habits are also known to play a big role in the prevention process.Reducing or Preventing Cases of Pressure Ulcers as an indicator of quality healthcare practices
Being that pressure Ulcers is entirely preventable, the ability of a Medicare or Medicaid center to deal with it is a clear sign that patients are given enough attention as required. Ulcer develops over time and medics are always aware of the condition that exposes a patient to condition leading to pressure ulcers. With knowledge in mind about a patient’s mobility, age and dieting status, health care facilities should be in a position to have the necessary resources to ensure that the patient is treated for the specific condition that they seek treatment for without exposing them to further discomfort that can result from pressure ulcers.
The Role of communication in the Prevention Process of Pressure Ulcers
In any given situation, having clear channels of communication between patients and healthcare staff is always of utmost importance. Apart from having the regular health information that is always availed on the medical forms, direct communication between the patient, Medicare staff and even the family at large can open new channels of information that can prove important in improving the quality of care provided. Vital information like new diet trends or even water consumption habits are elements that can easily be given a blind eye in the medical forms but the family can provide the information. In case a patient has started experiencing initial stages of ulceration, information regarding care given to the area prior to the medical visit can be provided by the family who in most cases, are always the primary care givers. This information can be reviewed by the medical staff to develop a better realistic option (Dlugacz,2009). Reasons for Healthcare Provider Reluctance in Discussing the Development of Pressure Ulcers
When it comes to discussing the implication of the development of pressure ulcer on patients with the patients themselves and even their family, medical staff can be reluctant with the fact that this can compromise their perceived quality of healthcare they provide. Healthcare givers find themselves in a better position with the idea that pressure ulcers can be prevented or maintained at the initial stages. According to the hospital acquired condition specifications, the medical institutions are always held responsible for the expenses that arise as a result of a patient developing conditions while in the institution (Stephen L. Isaacs, 2009). In relation to pressure ulcers, in case a patient develops stage three or four ulceration, this goes into the record of the accrediting bodies of which can negative affect an institution’s quality rating. The urge to maintain high quality rating can influence a Medicare institution’s willingness to share information about pressure ulcer development.
The Potential Ramifications or Non-Communication
The down side to a medical institution failing to discuss the development of pressure ulcers by a patient is that fact that whenever the patient is re-admitted, the family will have to pay for the expenses that will be accrued as a result of treating the ulcer rather than the hospital being held accountable. Apart from the financial aspect that comes with the condition, the health centers also try and reduce the instances that can put them in a position compelling them to be dropped in the quality rating. A reduction in the quality rating can easily affect the number of customers who they serve (Barbara Haag-Heitman, 2010).Information presentation by the healthcare staff
In order to be on the safe side of the law, healthcare centers are compelled to inform patients about their current medical situation before being discharged from the hospital. With this in mind, these centers are known to present the information about a patient developing mild pressure ulcers and the necessary care to be given more as a precautionary measure rather than as a result of their lower quality Medicare services (Zhong, 2013). This not only relieve them of blame but also of expenses that can result from taking care of the condition.
Expectations of the Joint Accrediting Commission
The joint commission comes in by working hand-to-hand with the medical institutions that fall under its umbrella. In regards to pressure ulcers, the joint commission is known to send agents who evaluate the way that patients are handled hence providing necessary advice in that regards. In case the agents observe that an institution’s ability to prevent hospital acquired conditions is relatively low, they are in a position to advice the management to conduct training or even an awareness program hence improving on the general healthcare provision service (Jcr, 2011).
In addition to being an extra eye and hand in the Medicare processes, the joint commission goes further to ensure that the rights and dignity of patients being treated for pressure ulcers are respected. To avoid finding themselves in the corridors of the law, the accreditation body expects the medical institution to handle a patient’s medical information with care hence not exposing it to outsiders.
Assessment by accreditation surveyors
The assessment process is always undertaken in collaboration with the medical team being that not only is the joint commission an agency to ensure quality, but also acts as an advising body to ensure quality is maintained (Jcr, 2011). The agents are known to have excess to patients’ records hence can determine if a condition is hospital acquired or not.
Outcomes related to cost and quality
It is common for organizations to aim for being able to provide quality services at the lowest cost possible. Due to the competitive nature in the medical industry, institutions have been known to work tirelessly toward developing continuous improvement strategies hence ensuring growth and survival in the field. Organizations have been known to take their staff through rigorous organizational learning program to create awareness of the organization’s mission, vision and how to achieve it. These include quality assessment trainings and also customer relation programs. Process reengineering is another aspect that medical institutions have accommodated to try and improve quality. It involves making drastic changes to old processes and embracing totally new processes that are aimed at quality improvement. In relation to pressure ulcer patients, a process reengineering can include buying massage beds rather than increasing the number of staff to periodically check on pressure ulcer patients. Internal changes can be made to ensure that patients get quality care. This goes hand in hand with localized improvement programs.
Having a medical team that is well aware of the conditions they are working in and also know what is expected of them in terms of performance is very important. Medical organizations are expected to have timely training and awareness program to ensure that its work force is well educated in their fields. When it comes to the common goal of attaining higher quality service at the cheapest cost, the idea of medical institutions working hand in hand with the joint accreditation agents is of utmost importance. This is a collaboration that can only bring more positive than negative ideas towards service improvement.
With all these improvement ideas in mind, in order to ensure that they are achieved, it is also vital to ensure that the Medicare and Medicaid centers are led by leaders who have high integrity and ethical standard. With that in mind, Proper quality is assured. This is a sure way of ensuring that the patients under medical care are in safe hands.
Conclusion
When it comes to the quality of medical care that we get, it is important to ensure that we get value for our money. In order to ensure higher standards in the medical industry, the introduction of the value-based purchase program surely aided greatly in making patients’ healthcare services better than before. In relation to patients who acquired conditions like pressure ulcers while in hospital, proper guidelines have been provided to ensure that the medical institutions are now able to be held accountable whenever they offer lower quality services that can prove to be harmful to unsuspecting patients.
References
Barbara Haag-Heitman, V. G. (2010). Peer Review in Nursing. Massachusetts: Jones & Bartlett Publishers.
Charney, W. (2012). Epidemic of Medical Errors and Hospital-Acquired Infections: Systemic and Social Causes. USA: CRC Press.
Dlugacz, Y. D. (2009). Value Based Health Care: Linking Finance and Quality. New York: John Wiley & Sons.
Houser, J. (2011). Book Alone: Nursing Research. Massachusetts: Jones & Bartlett Publishers.
Jcr, J. C. (2011). 2012 Comprehensive Accreditation Manual for Home Care (CAMHC). Illinois: Joint Commission Resources.
Stephen L. Isaacs, D. C. (2009). To Improve Health and Health Care. New York: John Wiley & Sons.
Zhong, W. (2013). An Introduction to Healthcare and Medical Textiles. Lancaster: DEStech Publications, Inc.
