Discussion: Quality and Cost Measurements

As nurse practitioners continue to expand their role in delivering health care, it is imperative for NPs to provide the data and evidence to demonstrate the impact of NP care on patient outcomes. There are several challenges that advanced practice nurses face to provide quality care and meet productivity goals of an organization. This week it is important to explore the connection of quality care and performance measures. Some questions to consider as we discuss this topic are:

• Why are quality measures important?
• What is the difference between quality measures and performance indicators?
• What performance measures are used for NP productivity?
• Why are incentive plans used in clinical organizations?

To prepare:

• Read the article, An Incentive Plan for Advanced Practice Registered Nurses: Impact on Provider and Organizational Outcomes, by Catherine A. Rhodes, Mavis Bechtle, and Molly McNett (2015)
• Explore quality measures and identify at least one clinical performance measure, such as the Agency for Healthcare Research and Quality (AHRQ)

Post an explanation of the importance of quality measures using the clinical performance measure you identified as an example. Then, identify the performance measures used for NP productivity in Rhodes, Bechtle, and McNett (2015) article. Finally, share your opinion on incentive payment for care, including external motivators and at least one business model

Answer:

1)

Quality measures are helpful in the identification of prioritizing opportunities, weakness, and identification of outcomes with improvements of nurse practitioners in healthcare. It can also reduce the misuse, underuse, and overuse of resources by the staff in healthcare services. Most importantly, it can identify various disparities in the delivery of nursing care and its positive or negative outcomes. The use of nurse practitioner specific quality measures can showcase the improvements in safety, quality, and cost of healthcare.

2)

Quality measures help us in measuring the outcomes, healthcare processes, and patient perceptions and structure of the organization that aims to provide healthcare of high quality

It is specifically associated with the patient population

It focuses on the service delivery to specific people

A performance indicator is a measurement that helps in monitoring, optimizing, and analyzing all the healthcare processes that re relevant to patient satisfaction

It focuses on the statistics of the whole population and is related to the whole population whether they required healthcare or not.

3)

Following are the ways to measure NP productivity:

Patient satisfaction:

There are few ways the performance of Np productivity is measured regarding the satisfaction of patient: first is the informal patient report, second is a formal metric that includes measurement of negative and positive comments on your delivery of health care to the patients

Patient care measures:

The organization is more concerned about your quality of healthcare delivery rather than just quantity of delivery. This can ensure the growth of the standard of respective organization

RVU:

Relative value units helps to score the healthcare provider's productivity level. Healthcare organizations that are financially focused are interested in the providers who generate high RVUs numbers.

4)

Clinical organizations use incentive plans to encourage and motivate the healthcare staff to improve their outcomes and perform well. They may use non-monetary or monetary incentives for better performance and increase standard of healthcare. This method can increase the quality of healthcare delivery. It increase the score of quality and attract others and increase the profit by increasing level of patient satisfaction

5)

QUALITY MEASURES:

Quality measures help us in measuring the outcomes, healthcare processes, and patient perceptions and structure of the organization that aims to provide healthcare of high quality

World Health Organization defines outcome measures in health care as changing the health status of an individual, or population that is the function of single or series of interventions.

We measure the quality and outcomes of healthcare to achieve its Quadruple Aims that are as follows:

Improve the population health

Improve the healthcare experience of the patient

Reduce healthcare per capita cost

Reduce burnout of staff and clinicians

6)

Clinical performance measure:

Health Resources and Services Administration:

The clinical performance measures of HRSA targets health conditions that are high priority and found in the safety-net population of HRSA, which are characterized by the Institute of Medicine.

7)

According to the Donabedian model, quality measures are classified into structural, outcome or process measures. These measures compare and assess the health care organization quality

Structural measures: This class provides a sense to the consumers about the capacity, processes and systems of health care providers to improve health care quality.

Process measures: This class indicates health improvement and maintenance by providers for diseased or healthy people. For example, the delivery of preventive service to certain percentage of people, and the percentage of diabetic patients who are tested and treated.

Outcome measures: It indicates the impact of healthcare intervention or service on patient's health status. For example, the mortality rate of surgery indicating the number of people who died due to surgery.

8)

Following are the NP productivity performance measures:

• MGMA data-based standards of productivity
• National measures for the quality data
• Scores of patient satisfaction
• Incentives for professional scholarships.

9)

1. Value-based payment or payment for care, consists of payment models that boost the performance of staff by financial insentives and disincentives. It is a national strategy that enhances healthcare value. Clinical organizations use incentive plans to encourage and motivate the healthcare staff to improve their outcomes and perform well. They may use non-monetary or monetary incentives for better performance and increase the standard of healthcare. This method can increase the quality of healthcare delivery. It increases the score of quality and attract others and increase the profit by increasing level of patient satisfaction
2. External motivators make more chances of nurses survival in their jobs. A contrast of external motivator is pro-social motivators that involve rewards based on job such as benefits, wages, or chances for promotion.
3. The business models for healthcare organizations are:

• Experience leader
• Health manager
• Product leader
• Integrator

Compensation and recognition incentives are the major criteria of incentive.