Reimbursement Models
Description
Develop a two-page memo to help relevant stakeholders at Vila Health’s St. Anthony Medical center better understand traditional and emerging reimbursement models.
***GRADING RUBRIC MUST BE FOLLOWED TO THE LETTER***
APA FORMAT
***MUST INCLUDE CITE-ABLE IN TEXT EXAMPLES***
Reimbursement Models
- Casto, A. B., & Forrestal, E. (2015). Principles of healthcare reimbursement (5th ed.). Chicago, IL: AHIMA Press.
- Chapter 1, “Healthcare Reimbursement Methodologies,” pages 126. This chapter will help you develop a foundational understanding of basic terminology and models of payment associated with health care reimbursement in the United States.
- Miller, H. D. (2009). From volume to value: Better ways to pay for health care. Health Affairs, 28(5), 14181428.
- This seminal article examines the potential quality pitfalls of volume-based health care reimbursement and advocates for methods that could drive an increase in value and quality.
- Miller, P., & Mosley, K. (2016). Physician reimbursement: From fee-for-service to MACRA, MIPS, and APMs. The Journal of Medical Practice Management, 31(5), 266269.
- This article examines how reimbursement has changed over the past century and the impact these changes have on practice and staffing strategies.
Accountable Care Organizations
- Centers for Medicare & Medicaid Services. (2016). Accountable care organizations (ACO). Retrieved from https://www.cms.gov/Medicare/Medicare-Fee-for-Serv…
- Centers for Medicare & Medicaid Services. (2016). Accountable care organizations (ACOs): General information. Retrieved from https://innovation.cms.gov/initiatives/aco/
- General information about ACOs. This page contains an overview video that presents the Pioneer ACO model, as well as links to specific ACO programs.
- Centers for Medicare & Medicaid Services. (2016). Accountable care organizations: What providers need to know [PDF]. Retrieved from https://www.cms.gov/medicare/medicare-fee-for-serv…
- PDF quick guide for health care providers to understand the characteristics, benefits, and risks of ACOs.
Healthcare Policy
- Oliver, T. R. (Ed.). (2014). Guide to U.S. health and health care policy. Los Angeles, CA: SAGE.
- The long, long road to national health reform (A short history). (2012). Modern Healthcare, 42(27), 1419.
- This article presents a timeline of important events and developments in health care reform.
Insurance
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- Casto, A. B., & Forrestal, E. (2015). Principles of healthcare reimbursement (5th ed.). Chicago, IL: AHIMA Press.
- Blumenthal, D. (2006). Employer-sponsored health insurance in the United States Origins and implications. The New England Journal of Medicine, 355(1), 8288.
- This article provides an overview of employee-sponsored health insurance in the U.S. and its implications for the cost of health care services.
- Graves, J. A., & Mishra, P. (2016). The evolving dynamics of employer sponsored health insurance: Implications for workers, employers, and the Affordable Care Act. The Milbank Quarterly, 94(4), 736767.
- This article examines recent trends in the types of insurance benefits offered by employees and the impact on participation. It also examines the ways in which the changing insurance environment affects individual, employer, and health care providers financially.
References:
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Clinical Guidelines
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Living Guideline
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Evidence-based practice
BMJ Best Practice
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JBI: Evidence summary
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JBI: Best practice information sheet
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Cochrane Database of Systematic Reviews
Srijithesh, P. R., Aghoram, R., Goel, A., & Dhanya, J. (2019). Positional therapy for obstructive sleep apnoea. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD010990.pub2
Drug Information
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Perth Children’s Hospital. (2022, April). Appendicitis [Emergency Department Guidelines]. Child and Adolescent Health Service. https://www.pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Appendicitis
Department of Health. (n.d.). Who is being active in Western Australia? https://ww2.health.wa.gov.au/Articles/U_Z/Who-is-being-active-in-Western-Australia
Donaldson, L. (Ed.). (2017, May 1). Healthier, fairer, safer: The global health journey 2007-2017. World Health Organisation. https://www.who.int/publications/i/item/9789241512367
NCBI Bookshelf
Rodriguez Ziccardi, M., Goyal, G., & Maani, C. V. (2020, August 10). Atrial flutter. In Statpearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK540985/
Royal Perth Hospital. (2016). Procedural management: Pre and post (24-48 hours) NPS. Canvas. https://courses.ecu.edu.au
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