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Addressing Social Determinants Of Health Assignment

Addressing Social Determinants Of Health Assignment

CMS Programs

End-Stage Renal Disease Quality Incentive Program (ESRD QIP)

The ESRD QIP measures care quality provided by dialysis facilities and reduces Medicare payments for facilities that do not offer quality care. The ESRD QIP features a set of health care quality measures. It captures reporting, outcome, and process measures as demonstrated by a dialysis facility’s performance and quality improvement. Facilities offered a yearly total performance score. Facilities whose performance is below the set cut-points have their payments reduced up to 2 percent of total Medicare payments (Griffin et al., 2023)Addressing Social Determinants Of Health Assignment.

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Hospital Readmission Reduction Program (HRRP)

The HRRP was in 2010 to minimize excess hospital readmissions. According to Psotka et al. (2020), readmission reporting began in 2010, while hospitals with higher readmission rates started being penalized in 2012. The goal of HRRP is to institute accountability and stimulate care coordination and quality care, especially during care transitions. Hospitals with more than the projected thirty-day readmissions after initial admission for pneumonia, acute myocardial infarction, and heart failure had their total inpatient Medicare payments reduced by up to 1 percent. In the following years, there was the addition of knee/ hip arthroplasty, coronary artery bypass graft surgery, and chronic obstructive pulmonary disease. Also, the maximum penalty was increased to 3 percent of total Medicare reimbursements (Psotka et al., 2020).

Hospital Acquired Conditions Reduction Program (HACRP)

The Hospital Acquired Condition Reduction Program (HACRP) incentivizes hospitals to ensure patient safety by reducing nosocomial infections. According to Vsevolozhskaya et al. (2021)Addressing Social Determinants Of Health Assignment, hospital-acquired infections (HACs) increase patients’ risk of having health complications in the future. They might also be an indicator that a hospital provides poor-quality care. Hospitals whose total HAC score is above the national standard are penalized 1% on their Medicare reimbursement.

Why it is important for health systems to incorporate ethical principles in resource allocation

Health systems should incorporate ethical principles in resource allocation to ensure fair allocation of scarce resources. According to Munthe et al. (2021), health systems must allocate limited resources, and the justification of resource distribution should adhere to ethical principles. These principles include cost-effectiveness, prognosis, need, prognosis, and equal treatment. A greater need for care is a justification for allocating more resources to assist a particular patient population. Prognosis implies that if an intervention has a greater impact, it is justified to allocate more resources. Equal treatment and equal priority for the allocation of resources are based on need and priority, including striking a balance between benefits and costs. Cost-effectiveness implies meeting a prioritized need with an intervention that is a priority should lead to unnecessary spending of more resources (Munthe et al., 2021)Addressing Social Determinants Of Health Assignment.

Incorporating ethical principles in resource allocation is crucial to ensure transparency, fairness, trust, and overall effectiveness of health systems. According to Yip (2021), an ethically justified allocation of resources must seek to achieve three goals: equity by treating all individuals in the same way; optimal efficiency in making decisions, such that resources are committed to individuals most at risk: and prioritization, implying that resources are accessible by most needy patients. Consistent, equitable, and transparent allocation mechanisms that respect stakeholders such as health professionals, patients, and clinicians ensure public trust.

How nursing as a profession can be involved in resource allocation to promote health equity

The nursing profession can be involved in resource allocation to promote health equity by working in partnership with the government to ensure the government complies with the principles of efficiency and fairness. According to Pu (2021), the government enables the appropriate allocation of health resources to different groups of individuals and institutions, thus making health resources more valuable and augmenting the benefits of society. Effectiveness and fairness are significant principles for allocating health and medical resources.

The nursing profession can improve health equity by advocating for patients and communities, as well as addressing social determinants of health (SDOH). According to Ahn et al. (2022), SDOH are connected with policies that contribute to inequities in the precursors of health, such as education, unemployment, and housing. Nurses are in a unique place to address SDOH by advocating for individual patients, communities, and populations. Also, nurses can minimize health disparities by advocating for the rights of patients and appropriate resources, such as transportation, financial aid, and caregiver networks (Ahn et al., 2022)Addressing Social Determinants Of Health Assignment.

References

Ahn, H., Butts, B., Cottrell, D. B., Kesey, J., McNeill, C. C., Mumba, M. N., O’Brien, T., Reifsnider, E., & Reilly, C. M. (2022). Partnerships to improve social determinants of health, health equity, and health outcomes: An SNRS whitepaper. Research in Nursing & Health, 45(1), 8-10. doi: 10.1002/nur.22198.

 Griffin, S. M., Marr, J., Kapke, A., Jin, Y., Pearson, J., Esposito, D., & Yung, E. W. (2023). Mortality Risk of Patients Treated in Dialysis Facilities with Payment Reductions under ESRD Quality Incentive Program. Clinical Journal of the American Society of Nephrology, 18(3), 356-362. doi: 10.2215/CJN.0000000000000079

Munthe, C., Fumagalli, D., & Malmqvist, E. (2021). Sustainability principle for the ethics of healthcare resource allocation. Journal of Medical  Ethics, 47, 90–97. doi:10.1136/medethics-2020-106644

Psotka, M. A., Fonarow, G. C., Allen, L. A., Maddox, K. E., Fiuzat, M., Heidenreich, P., Hernandez, A. F., Konstam, M. A., Yancy, C. W., & O’Connor, C. M. (2020). The Hospital Readmissions Reduction Program: Nationwide Perspectives and Recommendations: A JACC: Heart Failure Position Paper. JACC: Heart Failure, 18(1), 1-11. https://doi.org/10.1016/j.jchf.2019.07.012 Addressing Social Determinants Of Health Assignment

Pu, L. (2021). Fairness of the Distribution of Public Medical and Health Resources. Frontiers in Public Health, 9, 768728. doi: 10.3389/fpubh.2021.768728

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Vsevolozhskaya, O. A., Manz, K. C., Zephyr, P. M., & Waters, T. M. (2021). Measurement matters: changing penalty calculations under the hospital acquired condition reduction program (HACRP) cost hospitals millions. BMC Health Services Research, 21, 131. https://doi.org/10.1186/s12913-021-06108-w

Yip, J. Y. (2021). Healthcare resource allocation in the COVID-19 pandemic: Ethical considerations from the perspective of distributive justice within public health. Public Health in Practice, 2, 100111. https://doi.org/10.1016/j.puhip.2021.100111

Assignment Instruction

  1. Identify 3 of the 12 values-based CMS programs detailed in the text.  For each of the 3 identified please: (1) program name, (2) describe and (3) discuss what criteria are needed for healthcare facilities to be successful within each of the three values-based programs. Please post to the discussion thread.
  2. After reviewing the website shared this week, as well as any you find on your own, explain why it is important for health systems to incorporate ethical principles in resource allocation.
  3. Describe how Nursing as a profession can be involved in resource allocation to promote health equity.

Instructions.

I don’t have the text book yet but please assess values-based CMS programs via this link. https://www.cms.gov/medicare/quality/value-based-programs

Please click on tabs on the left to move from one program to the other

Please choose 3 out these 7 programs below and please cover all content as stated in the question Addressing Social Determinants Of Health Assignment

There are 5 original value-based programs; their goal is to link provider performance of quality measures to provider payment:

  • Choose End-Stage Renal Disease Quality Incentive Program (ESRD QIP)
  • Hospital Value-Based Purchasing (VBP)Program
  • Hospital Readmission Reduction Program (HRRP)
  • Value Modifier (VM) Program (also called the Physician Value-Based Modifier or PVBM)
  • Hospital Acquired Conditions (HAC)Reduction Program

Are there other value-based programs?

There are other value-based programs:

  • Skilled Nursing Facility Value-Based Purchasing (SNFVBP)
  • Home Health Value Based Purchasing (HHVBP)
  1. After reviewing the website shared this week, as well as any you find on your own, explain why it is important for health systems to incorporate ethical principles in resource allocation.

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Please see below for link for website.

https://www.healthequityandpolicylab.com/resource-allocation-2

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8536061/

https://www.ncbi.nlm.nih.gov/books/NBK435786/

  1. Describe how Nursing as a profession can be involved in resource allocation to promote health equity Addressing Social Determinants Of Health Assignment