Patient-based care encourages more patient choice , working together with the patient and support systems to manage the disease progress and necessary treatment needs .
Value based care teams such as this result in improved patient satisfaction through coordinated care and have greater economic efficiency with contractual partnerships for shared risk management .” choice , working together with the patient and support systems to manage the disease progress and necessary treatment needs . Value based care teams such as this result in improved patient satisfaction through coordinated care and have greater economic efficiency with contractual partnerships for shared risk management .
Under CMS a structure was established to calculate performance of hospitals based on quality domains that are adjusted each year . Currently more than 4,000 Medicare certified hospitals provide public reporting of the domain quality performance within the Hospital Compare website . The Hospital Consumer Assessment of Healthcare Providers and Systems ( HCAHPS ) and VBP establish the basis of the performance scoring for each facility for quality and cost measures .
Quality domains and weights for FY 2021 : Clinical outcomes ( 25 percent ) Person and community engagement ( 25 percent ) Safety ( 25 percent ) Efficiency and cost reduction ( 25 percent )
Acute-care hospitals are aligned through CMS to report outcomes within the domains that can result in incentive payments based on the quality of care they provide , rather than just the quantity of services . Within each of the hospital performance indicators Medicare spending is tracked , patient satisfaction scores are registered under the HCAHPS , readmission rates , VBP variables measured , and clinical care outcomes tabulated . Application of care strategies have resulted in improvements of patient satisfaction scores and improved quality of care , but challenges exist within implementation and sustainability of the measures . While care management process use is associated with positive increases in measures of hospital performance , the implementation of quality improvement initiatives initially results in higher cost than savings .
Hospital efforts to incorporate case management for specific practice areas may begin to see the vascular access teams to focus management on improved outcomes . The case management approach lends itself to these types of specialized groups to guide them from task orientation of catheter insertions to management and measurement of device selection , insertion , care , and timely discontinuation . The individual specialists on the teams also have insight
into product improvements and evidence supporting certain devices and practices that can benefit their facilities . While low-cost options for devices might seem the best approach , evidence says otherwise , lending credence to the old adage “ You get what you pay for .” Membership in GPOs gaining lower cost purchasing options may or may not provide the best value for improved outcomes since all GPOs do not function in the same manner . A balance of wise selection and lower cost purchasing is needed to optimize positive outcomes .
Many companies are working to develop and improve products within the vascular access and device arena that also promote the VBC and VBP models of care . Companies have improved catheter materials to incorporate more biocompatible catheter that include anti-thrombotic , and anti-infective properties . While high level evidence is lacking for these newer products , the potential for improved outcomes link with the VBP model . Other infection prevention devices with a growing body of evidence are the disinfecting caps and port protectors that protect the intravenous and arterial access points from contamination prior to the administration of medications or solutions . Companies are also making efforts to standardize ultrasound guided peripheral catheter insertions with transducer probe protecting covers . Reducing negative outcomes of blood build-up within a catheter and catheter occlusion also help to limit bacterial growth and catheter related infections . Blood reflux is controlled resulting in better outcomes with anti-reflux needleless connectors . Manufacturers spend considerable time and resources working to create products and devices to positively affect patient outcomes contributing to the VBC efforts .
Healthcare is rapidly evolving incorporating models , systems and products that enhance efficiency to reduce cost while improving outcomes . The VBC model , established by CMS , establishes national benchmarks and quartile levels of achievement setting the stage for outcome improvement . The weighted domains listed above are for reporting and scoring outcomes within the clinical , patient , safety , and cost reduction groupings for each hospital , with incentives built-in to reward the highest quartile level for quality care .
Rather than quantity of care , the new system bases quality on reduction of adverse events , adoption of evidence-based standards and protocols , and improved patient experiences in all settings with recognition that high quality care can be provided in a way that result in lower costs .
Nancy Moureau , RN , PhD , CRNI , CPUI , VA-BC , is the chief executive officer at PICC Excellence , Inc ., a research member of the Alliance for Vascular Access Teaching and Research ( AVATAR ) Group , and an adjunct associate professor at Griffith University in Brisbane , Australia .