How CMS impact the reimbursement model for Healing Hands Hospital and other healthcare organizations
Post-acute care refers to the assistance that patients receive once they are discharged from the healthcare setting probably at home or a nursing care home (CMS.gov, 2018). CMS regulations require the setting of the fixed amount of fees that a patient will incur throughout the health care program from the time they report to the health facility, receiving the care within the facility, and up to the point where they are discharged. The government pays the amount in bundle. If the healthcare facility manages to help the patient recover without spending the entire cost, they keep the rest of the money hence cost saving. However, the health care facility will have to incur the overcharge in case the cost goes beyond the fixed amount, which results in a loss (CMS.gov, 2018). The cost that is most likely to be saved is the post care cost if the health facility offers quality service within the shortest time possible.
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The CMS model enables the health facility to strategize by equipping the facility with better technologies and health workers. However, it strains the health facility as it tries to upgrade its standard but will be profitable in the long run to the health facility and the patient as well (Muhlestein, D. et al. (2018 ) . If the facility has to go through the entire process to the post care level, then it will make no savings and is likely to incur losses. Therefore, the program increases the cost of offering care such as the purchase of equipment, helps the hospital to reach a standardized level, helps patients to obtain quality care, and can help facility to save on operation costs. Nonetheless, it is disadvantageous if the facility does not take care of all costs accurately such as the costs of measuring blood pressure, laboratory tests, and data entry. Some of these tasks are minute and may be disregarded, but they contribute to the costs of health care.
The fragmented nature of post-care phase in healthcare sector creates a room for the players to integrate or consolidate and increase their market share. As a result, more players forming mergers and investing are investing in the post care section compared to other well-structured sections. This requires more regulations to focus on the strategic and standardized plans to prevent the exploitation of patients while guaranteeing quality care.
CMS reimbursement regulations for Medicare and Medicaid change and changes among insurance providers’ policies on reimbursement
The government contributes the greatest percentage in the payment of the CMS reimbursement fees, which is helpful to the citizens but has negatively affected the insurance firms. Most of the insurance firms are withdrawing their coverage or changing their insurance policies. CMS through payments of health coverage has become an insurance body requiring quality health care for its members who are the taxpayers. Thus, it can be noted that by taking the greatest share of the health cover, CMS has left little room for private insurance agencies to exercise their operations (DeWalt et al., 2005). Initially, CMS was introduced to cover only the elderly, but this could not be maintained since the elderly were receiving care from taxpayers' money, which necessitated the need of covering every citizen who is equally taxpayers (Muhlestein, D. et al. (2018).). This has introduced new dynamics in the insurance sector including limited insurance coverage.
References
CMS.gov. (2018). BPCI Model 3: Retrospective Post Acute Care Only . Retrieved from https://innovation.cms.gov/initiatives/BPCI-Model-3/
DeWalt, D. A., et al. (2005). The significance of Medicare and Medicaid programs for the practice of medicine. Health Care Financing Review, 27 (2), 79.
Muhlestein, D. et al. (2018). Recent Progress in the Value Journey: Growth of ACOs And Value-Based Payment Models In 2018. Health Affairs. https://www.healthaffairs.org/do/10.1377/hblog20180810.481968/full/
