Models of payment to healthcare organizations have begun to shift from paying for volume (fee for service) to paying for value (quality). Using a Venn Diagram, compare volume-based versus value-based reimbursement. Be sure the overlapping area contains the commonalities between the two systems.Use the editable template for the Venn Diagram, which is available for download above. This template (with your findings) will need to be posted as an attachment in your discussion post along with your written prompt.

Consider Jim, who is 69 years old and comes to your Emergency Department (ED) with severe abdominal pain. His evaluation, besides a physical exam, includes an abdominal ultrasound, a CT scan with and without contrast, multiple lab studies, all lead to his having an emergency appendectomy. Other than having Type II diabetes well controlled on diet and exercise, he is in otherwise good health. Jim is treated as an outpatient and is discharged home the next morning. Two weeks later he returns to the ED with fever, continued abdominal pain, and a surgical site infection. He is admitted and is treated for 5 days before being sent home.

Using your findings from your comparison of volume- versus value-based reimbursements, analyze the scenario. Determine how the hospital could charge and be reimbursed using the two methods. In this case, which would be better for the hospital? How do each of these payment models contribute to or detract from the goal of the Triple Aim? Considering payer mix, delivery systems, population demographic, and value-based purchasing of the institution. How do all of these elements influence the financing of the type and quality of care provided at your facility? What are the implications on access and availability of types of care provided by your institution?

Remember to support your thoughts with scholarly sources.

SOLUTION

The quality of care is reduced once the center utilizes volume based reimbursement. Jim might have been put through way too many assessments, typically appendicitis is identified as having only a CT or an ultrasound scan, both are generally not necessary. Additionally, Jim might have been discharged too soon after surgery to be able to make space for even more people, since they’re reimbursed by amount not quality. Because of the higher patient census and rushing of the release, mistakes tend to be more apt being made. Since Jim returned 2 days later with a post operative infection, he is going to receive the second bill of his for an emergency room visit, laboratory work, examinations, five day hospital stay, then drugs. This is the next time he’s charged since he was simply there 2 days earlier and was charged for the ER visit, the CT scans, the US, the post-operative and pre-operative drugs, the emergency treatment, and also the one night stay. This’s most being charged to the insurance (in case Jim has insurance) then Jim remains accountable for several of the bill that is usually extremely costly particularly if he’s a big deductible and has not met his deductible to market. Please click the purchase button to access the entire copy at $5