Guidelines for Touchpoint Reflections

Reflection Information

EXPERIENCE

Using the data collected in Week 1 about your institution’s, provide an overview of the payer mix , delivery system type, and the population demographics. Describe the type of reimbursement system relied upon most heavily by your institution; value- or volume-based.

REFLECTION

Describe how these factors coalesce to influence the financing of the type and quality of care provided at your institution. What are the implications on access and availability of types of care provided at your institution?

IMPLICATIONS FOR FUTURE

  • How is your proposed project affected by the information you’ve gathered about your facility?
  • What adjustments might you have to make in your proposal because of the information gathered?

Solution

From my experience working in the hospice setting for the last seventeen years, the reimbursement system has relied upon value-based reimbursement most heavily within the organization. Medicare & Medicaid Services (CMS) pays approximately 80% of reimbursement to the organization. Therefore, the organizations rely heavily on Medicare reimbursement. The organization receives reimbursement for hospice patients on services beginning day 1 to day 60 with a $203.40/day reimbursement. After the patient has been receiving hospice services greater than 61 days +, the organization receives a reimbursement deduction of $160.74/day, a difference of $42.66/day. The reduction of reimbursements to hospices occurred in 2016 because many hospice patients were dying alone. According to CMS (2022), the service intensity add-on was introduced, which is a unique form of payment when the registered nurse (RN) and social worker (SW) increase their visits. Visits are increased to provide clinical and psych-social needs to patients and the patient’s support team in the last seven days of life. Each visit must be a minimum of 15 minutes and a maximum of 4 hours/pay, only for the last seven days of the patient’s life. Factors coalesce to influence the financing of the type and quality of care provided at the organization by many entities. First, the organization must….Kindly click the purchase icon to  purchase the full solution at $5

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