healthcare processes, outcomes,
Quality measures are tools that help us measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care. These goals include: effective, safe, efficient, patient-centered, equitable, and timely care.” (CMS.gov, para 2, 2017). Many incentive models are used throughout different organizations. One model includes giving a percentage of profits to the provider after cost and benefits is paid from revenues (Rhodes et al., 2015). However, in areas where income is minimal (low-income or poverty stricken areas) this type of method would not be an enticing motivator.
What is the difference between quality measures and performance indicators?
A performance indicator is set technical specifications that define how to calculate a rate indicative of the quality of the performance (CMS.gov, 2017).
What performance measures are used for NP productivity?
The performance measure used by Rhodes, Bechtle, & McNett included the method of evaluating APNs performance through self, peer, supervisor, and ancillary staff evaluation as well as patient satisfaction data (Rhodes et al., 2015). APNs were notified of the plan through email and also emailed the surveys to complete. The results of these incentive measures increased job satisfaction by 1.6% despite the many changes the organization underwent (Rhodes et al., 2015).
Why are incentive plans used in clinical organizations?
These incentive plans are motivators for employees to increase their work performance through increased patient satisfaction, providing quality care, and broadening capabilities. The incentive plans often include increase in pay, bonuses, or other types of rewards. Incentive plans are ways for employers to evaluate employee performance and recognize good workmanship. Furthermore, “Incorporation of incentive plans can increase quality, patient satisfaction, and provider job satisfaction (Rhodes, Bechtle, & McNett, page 126, 2015)”.
Overall, the use of incentives can be a positive motivator for increasing APNs success by creating an environment of positive competition in the workplace by providing better service and quality care. So long as the models best fit the organization and area, they can work effectively. Routine evaluation is necessary to maintain such business models as health care and needs are forever changing.
References:
CMS.gov. (2017). Quality Measures. Centers for Medicare & Medicaid Servcies. Retrieved from: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/index.html?redirect=/qualitymeasures
Rhodes, C. A., Bechtle, M., & McNett, M. (2015). CNE SERIES. An Incentive Pay Plan for Advanced Practice Registered Nurses: Impact On Provider and Organizational Outcomes. Nursing Economic$, 33(3), 125-132.
Response # 2 to Mike Bird
Quality and Cost Measurements
Quality and improvement is an important aspect of the profession of Nurse Practitioners (NP). Several areas of incentive pay plans have a direct impact on excellence, as well as being cost effective throughout the health care setting (Rhodes, Bechtle, & McNutt, 2015). The purpose of this discussion post is to explain the importance of quality measures using clinical performance measures in regards to patient satisfaction and to identify the performance measures used for NP productivity. Finally, the opinion of the author on incentive payment for care, including external motivators and at least one business model, will be addressed.
Patient Satisfaction and Performance Measures
In the article by Rhodes et al., (2015), several incentive plans are discussed and provide evidence that incentive plans can increase quality, patient satisfaction, and provider job satisfaction. Patient satisfaction is a quality that is often measured for reimbursement from Medicare and Medicaid recipients and studies have shown that NPs hold an advanced degree which includes health promotion, disease prevention, health education, counseling, and diagnosing and managing acute and chronic conditions (Liu & D’Aunno, 2011). Time restraints for physicians on wait times for appointments and treatments are directly associated with patient satisfaction scores, and utilizing NPs in the clinical setting has shown to reduce the amount of time a patient has to wait to see a provider (Pickard, 2014). In most cases, NPs are able to assess and treat many of the clinic patients before the physician is able to visit with the patient, which gives the NP more time to educate and counsel the patient on health management and healthy lifestyle changes (Pickard, 2014). The added time that the NP has with the patient increases satisfaction because information is provided on their medications, disease processes, and lifestyle changes, which patients appreciate, and in turn, increase their satisfaction with the health visit (Pickard, 2014). Although patient satisfaction is only part of the pay-process for providers, it is a vital component in reimbursement for many insurance companies, as well as state and federally funded programs for health care coverage.
NP Productivity
Simply counting the number of patients that an NP assesses is only part of the picture when measuring productivity in health care. Patients are all different and present with a variety of symptoms, comorbidities, treatment options, and varied amounts of time it takes to provide individual care (Pickard, 2014). Relative value units (RVUs) have been established to indicate the resources that are required to determine physician fee schedules, although, NPs are not often included or utilized in these models of payment (Rhodes et al., 2015). The key factors that influence productivity are volume, cost, work effort, and revenue, whereas, the factors influence the final result of productivity are quality, efficiency effectiveness, and patient satisfaction (Pickard, 2014). NPs offer much more than the RVU measures for reimbursement. The Advanced Practice Registered Nurse (APRN) has a direct effect on patient education and patient satisfaction which is not measured by the use of RVUs (Pickard, 2014).
Incentive Payment for Care
RVUs measure the resources that are used when treating patients, and is utilized by physician services but are not always utilized with incentive plans for NPs (Rhodes et al., 2015). Incentive plans that include the core competencies of health education, promotion, and counseling for healthy lifestyle changes should be implemented into an incentive plan that allows NPs to charge for these services. Integrating these services with clinical productivity incentives measured by the Medical Group Management Association (MGMA) for non-physician providers would add motivation to utilize the education that APRNs work so hard to achieve. In the clinical setting, NPs and physicians should work as a collaborative team for patient treatments and positive outcomes and should both be compensated appropriately.
In the hospital setting, where the author is employed, NPs are utilized in the “Fast track” area of the Emergency Room which sees patients that are of a lesser acuity and need fewer resources for treatment. The NP assesses, educates, counsels, diagnoses, and prescribes medications for these patients, but the physician charges the patient an RVU when the Doctor goes in and asks the patient “how was your visit?” The physician and the hospital are compensated for the visit, and the NP gets no compensation or credit for the stay. Because there is no incentive for NPs to see patients in a timely fashion (other than job security), the turn-over rate and burnout for these practitioners are high within the department. The study that was conducted by Rhodes, Bechtle, & McNutt (2015), explains the importance of retention and the use of incentives to increase productivity, patient satisfaction, and student/staff training to name a few.
Business Model
For NPs that want to become independent, a business plan for opening a sovereign practice might be an option if the practitioner wants to be fully compensated for the work that they do. Business plans are vital if a business is to succeed, and these plans include assessing, identifying problems (diagnosing), developing interventions, implementing solutions, and evaluation of the activities (Harris, 2013). The initial components of contemplating an independent practice look very similar to the knowledge that NPs use in diagnosing and treating patients. Although there are other components to a business plan, NPs are in a unique position to understand the process of a business plan. Depending on the state that the practitioner resides, or decides to practice, it is imperative that the practitioner becomes aware of the state and federal regulations for undertaking a potentially rewarding and lucrative task. Self-employed NPs are responsible for keeping up with outside measures and performance, and patients will go to providers that who will be accessible and who will be reimbursed by the patient’s insurance plan (Buppert, 2018). Providers that are driven by meeting the standards that research shows can increase patient outcomes and satisfaction, will thrive as an independent business (Buppert, 2018).
Conclusion
NPs are a vital member of the health care team in any setting and they bridge the gap in access to providers. Practitioners are trained to educate, counsel, diagnose, and treat illnesses associated with a variety of patients that they assess, and should be compensated appropriately for their services. Studies have reported that APRNs are dissatisfied with the lack of monetary bonuses, reward distribution, and compensation for activities beyond their regular duties (Buppert, 2018). A change in the use of RVUs to compensate for the work that NP’s do on educating, counseling, increasing patient satisfaction scores, and outside activities, such as professional leadership roles in the community, should be included to properly reimburse the NP for the important role they play in health care.
References
Buppert, C. (2018). Nurse practitioner’s business practice and legal guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.
Harris, S. J. (2013). Start-up private practice business plan for advance practice nurse practitioner in Northeast Iowa. Retrieved from http://www.scholarworks.montana.edu
Liu, N., & D’Aunno, T. (2011). The productivity and cost-efficiency of models for involving nurse practitioners in primary care: A perspective from queueing analysis. Health Services Research, 1-20. https://doi.org/10.1111/j.1475-6773.2011.01343.x
Pickard, T. (2014, March-April). Calculating your worth: Understanding productivity and value. Journal of the Advanced Practitioner in Oncology, 5(2), 128-133. Retrieved from https://www.ncbi.nih.gov/pmc/articles/PMC4093517/
Rhodes, C. A., Bechtle, M., & McNutt, M. (2015, May-June). An incentive pay plan for Advanced Practice Registered Nurses: Impact on provider and organizational outcomes. Nursing Economics, 33(3), 125-131. Retrieved from Walden University Library database