The value-based purchasing (VBP) program in healthcare is a program of the Centers for Medicare and Medicaid Services (CMS). It focuses on requiting acute-care hospitals with incentives on the basis of quality service provision to Medicare and Medicaid recipients ( Klein & Shoemaker, 2012) . The purpose of this program is to motivate an organization into offering excellent health services to patients and other healthcare consumer that makes them willing to pay for their value. As a result, the VBP program targets to remunerate service providers on the basis of the excellent work as opposed to the quantity of service provided. In health terms, the quality of health care provision is determined by considering the rate of patient satisfaction and their experiences in the hospital. This can be measured using factors such readmission rates, post-care complications, rates of recovery and the interaction with service providers ( Klein & Shoemaker, 2012) .
A1. VBP Degree of Implementation
The Baycare Health System was selected for implementing the value-based purchasing due to its need to improve quality of healthcare provision. The hospital received the idea of implementing VBP in the organization with a mixed reaction, with some appearing excited while others appearing less interested in the idea. The idea was not expressly accepted to be adopted in the health facility since the proposal was not consulted before being introduced. However, despite members showing mixed reactions to the idea of implementing VBP in the organization, the management fully accepted the idea of integrating value-based purchasing and went ahead with plans to facilitate its implementation. The organizational leaders bought into the idea and importance of integrating VBP into the organization, which saw them lobbying all other members to come aboard and dig into the idea. This helped deal with any form of resistance that could interfere with appropriate implementation of the program.
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As a result, the administration agreed to review the proposal based on its commitment to improve the quality of care provision and the safety of all patients. The American Hospital Organization (AHA) reviewed the project by looking at how the hospital is committed to improving its service provision The Hospital Quality Alliance (HQA) was created to also help in reviewing the proposal and steer transparency ( Klein & Shoemaker, 2012) . Through this alliance, hospitals are allowed to provide information regarding the quality of care for several clinical procedures that can determine their effectiveness in healthcare.
The review of this proposal led to developing essential principles of the VBP program that makes it an important part of the organization. These principles were not formed to contradict the position of CMS reimbursement regarding VBP, instead streamline it for the best of the program. The first principle was linking the hospital with the physicians and other incentives, with a call to pay special attention to creating performance measures across different departments. Thus would help the organization to drive towards a achieving the common objective of improving healthcare performance ( Klein & Shoemaker, 2012) .
The second principle focused on the collaborative development of incentive approaches for both the health provider and the CMS. The collaboration between employees in a hospital and CMS allows for consultations to come up with shared objectives, measures, and payment methods. The partnership can help in reducing the multiplicity of request for information data.
Furthermore, the third principle was determining the overall goal of VBP, which is to improve the performance of health care providers in terms of quality and patient safety. The VBP program was also established as one way of reducing costs by CMS reimbursement ( Klein & Shoemaker, 2012) . However, the HQA found that cost of service should not serve as the basis of paying incentives, since both the intrinsic and extrinsic factors determine the value.
Incentive rewards were also established to motivate behavioral change in the organization. The incentives would motivate the staff to improve their performances without placing too much risk. It also emphasized the need to reward an organization for both quality attainment and quality improvement. The aim is to motivate all facilities that have attained or improved quality performances in health provision.
At the same time, there were recommendations to develop measures that can be used in performance assessment. These measures should be developed in the most ethical way, including ensuring the process is free, fair, and consensus since they serve the role of streamlining performance measurement and reporting ( Maile et al., 2016) . The performance assessment was required to be based on testable and feasible evidence, which means only reliable and highly valid parameters should be applied during field-testing practice. Similarly, the performance measures were required to minimize any form of bias by recognizing differences existing among hospitals and the type of patients served in each facility. The parameters should also act according to the traditional existing care disparities. In essence, the leaders managed to convince all members into collaborating to implement the VBP program in the organization.
B1. Departments Impacting VBP
Several departments within the hospital organization are crucial in facilitating the functioning of the health facility. In this paper, three departments with the highest impact on VBP implementation and operations are discussed. They include the human resource department, medical unit as well as the administration. This is because they are primarily involved in the implementation and functioning of VBP within the hospital.
B1a. Roles and Functions of the Departments
Human Resource Department
The human resource department of a health organization is involved in various tasks that touch on employees. These functions can be crucial in implementing the VBP program and, therefore, essential in its operation and management. The human resource department engages in the roles of attracting and hiring the most talented employees in the organization who are suitable for the specialties related to the CBP ( Maenhout & Vanhoucke, 2013) . It also performs the purpose of promoting and applying policies that will help in defending employee interest while implementing the program. At the same time, the human resource department helps in bringing up-to-date working techniques and ensuring they are in tandem with modern technology. These techniques are crucial in ensuring the organization meets the required quality that improves patient experience and satisfaction. They also help in keeping information with confidentiality compared to traditional methods.
Medical Department
The medical department is another unit in the healthcare department that provides the actual health care services to the public. They participate in functions such as surgery, inpatient and outpatient services, nursing, pediatrics as well as maternity services. The primary role of the medical department is to administer treatment, prescribe drugs, make a diagnosis and clinical assessment as well as perform surgeries. A health facility can have numerous medical departments playing different roles, depending on the size and specialization of a facility. The medical unit occupies the central stage in implementing the VBP program, as it determines how the VBP incentives or penalties paid ( Klein & Shoemaker, 2012) . This is because the groups have the role of receiving, handling and managing patients while providing quality care services.
Administration Department
The administration department is involved in the overall management of the health organization and performance of all departments. In a hospital, the administration department is responsible for making policies towards healthcare and engaging in follow-u plans ( Maenhout & Vanhoucke, 2013) . At the same time, the administration department engages in supervising and coordinating the VBP program with the CMS. Whenever the hospital facility is engaging with the CMS reimbursement, the administration has the representation role. These are important functions
B2. Departmental Goals
Human resource department
The objective of the human resource department in facilitating VBP program implementation is to hire the most reliable and effective employee with the ability to integrate VBP programs. The human resource should have the needed skills and knowledge to manage and operate the program, which is crucial in enhancing performance and achieving the stipulation of CMS reimbursement ( Maenhout & Vanhoucke, 2013) . Therefore, the department should be in a position to attract the best talents who can improve the performance of the program, and update work techniques to ensure they integrate with the approved techniques. Getting the most qualified employees is crucial in enhancing the performance of VBP program in the organization.
Medical department
The medical department performs several goals towards implementing the VBP program in the health facility. The overall goal of the medical department is providing quality health services to patients within the shortest time possible. The department also has to ensure the safety of patients by using the most efficient techniques of medical services, while upholding the core values of the hospital ( Maenhout & Vanhoucke, 2013) . Lastly, the medical department has the role of maximizing the quality of service provision as opposed to the quantity, which is an essential part of attracting the best incentive payments.
Administration department
The administration department also plays a vital role when seeking to develop a VBP program due to its oversight role. The first role of the administration department is to implement policies and procedures that will facilitate quality healthcare provision in the health facility. The organization will focus on achieving the specific quality standards that are needed to achieve the highest health care efficiency ( Maenhout & Vanhoucke, 2013) . At the same time, the administration department has the goal of coordinating communication between CMS and the facility based on the VBP implementation. A lack of proper coordination can affect proper application as employees will not understand the whole subject to embrace it.
B3. Attaining quality
The key to achieving excellence in a health organization is to implement the correct policies and plans with clear objectives. The administration department plays a crucial role in attaining quality by managing and implementing programs that can increase quality outcomes and meet the designated quality performance ( Maenhout & Vanhoucke, 2013) . This would result in serving patients appropriately using the best techniques and tools. The hospital attains quality outcomes by reducing patient wait times, readmission rates, and more extended hospital stays. This would translate into a better patient experience that shows the patient is served appropriately. Appropriate coordination between the facility and CMS will help in promoting timeliness reimbursements.
Secondly, quality outcomes can be attained by hiring the best personnel to facilitate the implementation. This is the function of the human resource department, which is mandated with ensuring they get the best staff who will enhance patient safety and care. Providing quality patient care services translate to payment of incentives to the performers. This is only possible when an organization has the right personnel with the necessary skills and expertise that can allow for implementing the VBP program ( Klein & Shoemaker, 2012) .
At the same time, the organization can attain quality outcomes by focusing on offering affordable care services without compromising the quality. This is the only way of enhancing the patient experience within the health facility and gaining their trust. Increasing patient satisfaction is a sure way of improving quality outcomes. The patient experience and comfort are a possible reimbursement method by the CMS initiative. The focus is to maximize the quality of care provision in the organization as opposed to the quantity as one way of implementing the VBP program ( Klein & Shoemaker, 2012) .
B4. Critical Key Points
There are several essential points that all medical staff in a health organization need to understand regarding the CMS reimbursement. The first point is that the incentives are awarded on the basis of excellent quality products offered within the organization. It also considers the manner in which an organization follows clinical practices as well as its effectiveness in enhancing patient safety and experience while in the health facility.
The second critical point is for the staff within the organization to understand how Medicare makes incentive payments to health organizations. For example, payments are made depending on how well the hospital performs on each measure. After that, they are made based on how much the hospital improves the quality of its service provision when measured during the baseline period.
The third critical point for all staff members to understand is that CMS measures capture several different domains. Some of the domains captured in this hospital include clinical care, patient experience, safety, and efficiency ( Wannisky, 2002) . This entails examining patient experience and satisfaction as measured by the HCAHPS survey measure. The critical point focuses on evaluating the process of clinical car, effectiveness of medical spending, patient safety as well as the outcome of clinical care.
B4a. Marketing the Key Points
The implementation of this program will require marketing its key message to all staff members. This will ensure all members understand the importance of this initiative and embraces it throughout the organization. The purpose of this marketing plan is to communicate the importance of implementing the project and ensure employee support and corporation.
The marketing of this program and key points will be facilitated through several strategies: some of the plans include holding seminars and workshops. The administration can organize seminars and workshops within the organization where they invite CMS directors to come and explain in depth the focus of the VBP program and its importance ( Klein & Shoemaker, 2012) . The seminar allows medical staff and employees a chance to learn and ask questions regarding this initiative and why it is important. The seminar and workshop also allow medical staff to understand the implications of this program to patients, employees, and the hospital at large.
The seminars and workshops also provide an opportunity for the hospital administration to organize training programs in various areas of quality services. For example, the training program can focus on enhancing patients’ experience of care, quality clinical practices, fields, and measurements that will improve during the baseline period ( Wannisky, 2002) .
At the same time, the organization can market the critical points by organizing departmental assemblies to present the essential aspects of the project to the medical staff in respective departments. Lastly, the marketing of crucial points of this program can be done through organizing interdepartmental appraisal within the health organization. This appraisal will look towards motivating and inspiring medical staff into improving their care services to patients.
B5. Ethical Clinical and Ethical Business Practices
Every profession is guided by ethical practices, defined as policies put in place to determine confines for carrying out operations in an organization ( Bowen, Hung-Baesecke & Chen, 2016) . In this program, the organization will be required to uphold two primary ethical business practices of compliance and working with suppliers. The implementation of these ethical business practices will play a bigger part in the performance of this VBP program. These principles will be incorporated in implementing the VBP program in the organization by mandating everyone to act in the best ethical practices possible ( Bowen, Hung-Baesecke & Chen, 2016) .
The first ethical business practice will be compliance, which entails complying with the codes of ethics and standards needed in the health facility. The agreement allows an organization to operate within the set standards. Furthermore, all employees will be required to act diligently, reasonably, and carefully to ensure they comply with ethical requirements ( Bowen, Hung-Baesecke & Chen, 2016) .
Another ethical consideration will be maintaining a reasonable, sustainable, and reliable supply chain that can help an organization to support all domains of medical service. The ethics are considered when working with suppliers to avoid making mistakes that can affect the relationship.
Other ethical considerations will involve maintaining the autonomy of patients, which consists of giving patients a choice to either accept or reject actions. Informed consent is another ethical clinical practice that will go with the VBP program, which allows patients to make decisions after providing them with adequate information ( Bowen, Hung-Baesecke & Chen, 2016) . Thirdly, the ethics of dealing with patients include fidelity, which requires physicians to maintain the trust and confidence of patients.
Beneficence will also be given prominence as an ethical concern for the organization, which ensures that physicians focus on doing what is good for the patient. Surrogacy is another ethical consideration for the organization, which entails physicians involving patients in making decisions or finding other individuals who can decide on the patient’s behalf. It is used in situations where the patient is incapacitated to make decisions regarding diagnosis and treatment ( Bowen, Hung-Baesecke & Chen, 2016) .
The organization will, through the human resource department, focus on hiring employees who are well placed in incorporating these ethical practices in implementing the VBP program. Furthermore, the organization will facilitate ethical practices through capacity building opportunities to medical staff, as well as subjecting every employee to an oath of allegiance ( Bowen, Hung-Baesecke & Chen, 2016) . Introducing an appraisal system will also be in the cards as a measure of ensuring compliance with ethics.
B6. Coordinating Events among Identified Department
The organization will be required to coordinate the activities among several departments when implementing the VBP program. The coordination will be facilitated by bringing on board the heads of the three departments involved in implementing this program. The leaders of departments will also have the responsibility of dealing with all the information deemed crucial in managing and coordinating events among departments. They will work by bringing their different ideas and strategies together to facilitate coordination activities ( Wannisky, 2002) .
Their other responsibilities in coordinating events will include organizing their departments, put in place several strategies, and nominate candidates for educational programs and capacity building. They are also required to collaborate with other relevant departments in executing the implementation plan. This means they coordinate with other departments in facilitating the seminars, workshops, and training programs.
There are several ways that departments can coordinate information and education events within the organization to improve productivity of the program. Collaboration between departments involves excellent communication and in-depth understanding of each other’s role in a project. The administration, human resource and medical department will coordinate team building efforts and share information regarding the VBP program by conducting shared seminars and workshops. At the same time, the departments can connect through technological means such as social media forums where they share ideas and teach each other on the program. This entails improving the inter-departmental communication by restructuring the procedure method. For example, the rules must ensure team members always communicate in a polite manner and that information is distributed
B7. Timeline
There will be a designated timeline for implementing this VBP program that is summarized in the table below. This diagram is developed by considering how the organization can improve the quality of its healthcare services within the next three years. It is based on the baseline period, as well as the performance period expected of each domain.
| Domain | Baseline period | Performance period |
| Efficiency and cost reduction | April 1 to May 1, 2019 | January to December 2019 |
| Safety concerns | July 1 to July 31, 2019 | March to December 2019 |
| Patient centered and caregiver experience of care | June 1 to August 31, 2019 | January to December 2019 |
| Clinical care | March 1 to May 3,1 2019 | January to June 2019 |
C1. Executive Summary
The Baycare Health System has participated in the CMS reimbursement program, and agreed to implement the VBP program. The program was part of initiatives that the organization implemented as a way of improving the delivery of healthcare services to its clients. The implementation involved selecting several domains such as clinical care, patient experience, safety, and efficiency that were the focus of this strategy. For example, the organization emphasized open communication strategies across the organization, involving all levels of administration and all stakeholders in the program. Communicating with medical staff would improve the HCAHAP scores while enhancing the delivery of quality patient care services.
C2. Preparation for Implementation
The three departments of administration, human resources, and medical units will partner in implementing the VBP program and ensure its success. The departments will prepare for implementation through necessary training to improve on the skills of VBP management and ensure they have the right attitude and mentality to continue being productive. The administration and human resource departments help in uniting physicians with the hospital staff in developing a medical environment that improves patient experience and satisfaction ( Wannisky, 2002) . On the other hand, the medical unit prepares through training and education to improve their skills.
The medical unit will be at the forefront of implementing this initiative, with the medical director leading other physicians in promoting a multidisciplinary approach. The team will comprise of several specialties, including clinical and case management specialties and nursing educators, who will serve the role of consultants in creating an active program for the organization. The focus of this program is to train staff members and ensure they provide the highest quality healthcare series that improves hospital experience by reducing mortality and sequel. The physicians will then be required to attend training sessions to enhance their skills in VBP management, which will improve their performance in the hospital setting.
The administration department will also play a crucial role in implementing this program. They will provide the leadership needed to propel the initiative by motivating medical staff and other stakeholders affected by the program. The administration will work towards incorporating all staff members in action before implementation. Communication is an essential component of facilitating collaboration within the organization as it allows different departments to share in care provision.
Furthermore, the human resource department will prepare for implementation by providing the necessary resources and help needed to prepare physicians. A team comprising of a nursing director, chief medical officer, human resource manager, and selected medical staff members will lead consultation measures to prepare members for the implementation. They will be working with other third parties to address the VBP program and its implementation.
C3. Necessary education and training
The team will have the responsibility of leading the training and education program on the VBP program ( Wannisky, 2002) . They will involve other staff members in mock situations before implementing the program, which will ensure all employees understand the importance of this initiative. Furthermore, the team will look towards marketing the action to the community to make them aware of this program and its relevance to patients. The medical staff will be trained on how to market the initiative and improve their skills on how to be productive with the new changes. Each of the three departments will hold separate training lessons and workshops focusing on specific aspects of their work. In essence, the medical unit is the most crucial department needing training to ensure staff members provide high quality healthcare services.
References
Bowen, S. A., Hung-Baesecke, C. J. F., & Chen, Y. R. R. (2016). Ethics as a precursor to organization–public relationships: Building trust before and during the OPR model. Cogent Social Sciences , 2 (1), 1141467.
Klein, E., & Shoemaker, P. (2012). Value-based purchasing: a preview of quality scoring and incentive payments: findings of a recent study suggest that some types of hospitals participating in CMS's Value-Based Purchasing (VBP) program can expect to perform much better than other types. Healthcare Financial Management , (1). 64.
Maenhout, B., & Vanhoucke, M. (2013). Analyzing the nursing organizational structure and process from a scheduling perspective. Health Care Management Science , 16 (3), 177-196.
Maile, E., Harrison, J., Chikura, G., Russ, K., & Conroy, S. (2016). Ethical issues in clinical practice: Ethical issues for older people in the emergency department. European Geriatric Medicine , 7 372-378
Report to Congress: Plant to Implement a Medicare Hospital Value-Based Purchasing Program (2007). U.S. Department of Health and Human Services
Wannisky, K. E. (2002). Department of Health and Human Services, Centers for Medicare and Medicaid Services [electronic resource]: Medicare program: update to the prospective payment system for home health agencies for FY 2003 . [Washington, D.C.] : U.S. General Accounting Office, [2002].
