PART A: What is the basic difference BETWEEN Fee-For-Service Payments and Bundled Payments, which are the two (2) main ways to pay providers for delivering Personal Health Care Goods and Services? (HINT: How do those terms relate (respectively) to the restaurant terms A La Carte and Prix Fixe?)
PART B: Give ONE (1) positive effect of Fee-For-Service Payment on the behavior of a clinical provider, and ONE (1) positive effect of a Bundled Payment on the behavior of one or more clinical providers.
PART C: Give ONE (1) negative effect of Fee-For-Service Payment on the behavior of a clinical provider, and ONE (1) negative effect of a Bundled Payment on the behavior of one or more clinical providers.
QUESTION 2: PAYING FOR HOSPITAL SERVICES: TWO APPROACHES
USING ATTACHED READING 3. AND READING 4. ALSO POWERPOINT 10 – PART 2, SLIDE 5.
PART A: PER DIEMS AND DIAGNOSIS RELATED GROUPS: Briefly describe the difference between the Per Diem approach to paying for Non-Physician Hospital Services, and the DRG (Diagnosis Related Group) approach to paying for those services.
PART B: Who is more likely to use DRGs to pay hospitals and Integrated Delivery Systems for inpatient hospital services?: Private commercial insurers, or Medicare?
PART C: Who is more likely to use Per Diems to pay hospitals and Integrated Delivery Systems for inpatient hospital services: Private commercial insurers, or Medicare?
QUESTION 3: BUNDLED PAYMENTS: BASIC PRINCIPLES; DIAGNOSIS RELATED GROUP EXAMPLE.
USING ATTACHED POWERPOINT 10 – PART 2, SLIDES 3-6; READING 5. ON DRGS; READING 6 ON BUNDLED PAYMENTS.
PART A: DIAGNOSIS RELATED GROUPS (DRGs):
Briefly describe ONE (1) Strength or positive aspect of DRGs as a bundled payment system for paying for Non – Physician Hospital Services.
PART B: DIAGNOSIS RELATED GROUPS (DRGs):
Briefly describe ONE (1) Weakness or negative aspect of DRGs as a bundled payment system for paying for Non – Physician Hospital Services.
PART C: Generally speaking about Bundled Payment Systems: What types of clinical groups (patients with specific diagnoses, patients receiving certain surgical or medical procedures) are the best candidates for creating and using Bundled Payments? Why are they the best candidates?
BASICS OF PERFORMANCE INDICATORS/QUALITY MEASURES: USING PERFORMANCE INDICATORS
QUESTION 4: PERFORMANCE INDICATORS/QUALITY MEASURES – TYPES AND DEFINITION.
USING ATTACHED POWERPOINT 15, SLIDES 3-4, 14-25.
READING 7.; READING 7.A.
PART A: What is a Performance Indicator/Quality Measure?
PART B: What is the difference between an Outcome Indicator and a Process Indicator of Performance?
PART C: What is ONE (1) key information source for monitoring Performance Indicators?
QUESTION 5: PERFORMANCE INDICATORS – HOW THEY ARE USED.
USING ATTACHED POWERPOINT 15, SLIDES 20 AND 23.
READING 7, PAGE 12.
Briefly describe TWO (2) of the main ways in which Performance Indicators are used by commercial insurance plans, Medicare, and Medicaid.
QUESTION 6: PERFORMANCE INDICATORS – THE NCQA AND THE HEDIS INDICATORS.
USING ATTACHED POWERPOINT 15, SLIDES 3-4, 15, 21.
READING 8.
PART A: Briefly describe what the National Committee on Quality Assurance (NCQA) is and does.
PART B: Briefly: What are the HEDIS Performance Indicators?
PART C: Give ONE (1) example of a HEDIS Performance Indicator.
PART D: Does the NCQA use HEDIS Performance Indicators in its Accreditation process? YES OR NO?
QUESTION 7: PAY FOR PERFORMANCE: THE CONCEPT/ RELATIONSHIP TO PERFORMANCE MEASURES
USING ATTACHED,
POWERPOINT 10 – PART 1, SLIDES 14 AND 15.
READING 9.
ANSWER THE FOLLOWING:
PART A: What is basic idea of Pay-for-Performance (P4P)? – In other words, how is this form of payment expected to positively impact on the behavior of clinical providers? (Doctors and hospitals, for instance.)
PART B: What is the connection between Pay-for-Performance and the collection and analysis OF clinical provider Performance Indicators?