HCA 675 What are the pros and cons of a DRG payor system, and a capitated payor system?

Grand Canyon University HCA 675 What are the pros and cons of a DRG payor system, and a capitated payor system?-Step-By-Step Guide

This guide will demonstrate how to complete the Grand Canyon University HCA 675 What are the pros and cons of a DRG payor system, and a capitated payor system? assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for HCA 675 What are the pros and cons of a DRG payor system, and a capitated payor system?                            

Whether one passes or fails an academic assignment such as the Grand Canyon University HCA 675 What are the pros and cons of a DRG payor system, and a capitated payor system?  depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for HCA 675 What are the pros and cons of a DRG payor system, and a capitated payor system?                          

The introduction for the Grand Canyon University HCA 675 What are the pros and cons of a DRG payor system, and a capitated payor system?  is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for HCA 675 What are the pros and cons of a DRG payor system, and a capitated payor system?                          

After the introduction, move into the main part of the HCA 675 What are the pros and cons of a DRG payor system, and a capitated payor system?  assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for HCA 675 What are the pros and cons of a DRG payor system, and a capitated payor system?                          

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for HCA 675 What are the pros and cons of a DRG payor system, and a capitated payor system?                            

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for HCA 675 What are the pros and cons of a DRG payor system, and a capitated payor system? 

Re: Topic 2 DQ 1

DRG stands for diagnosis-related group.The idea behind DRGs is to ensure that Medicare reimbursements adequately reflect “the fundamental role which a hospital’s case mix [ie, the type of patients the hospitals treats, and the severity of their medical issues] plays in determining its costs” and the number of resources that the hospital needs to treat its patients. The advantages of the DRG payment system are reflected in the increased efficiency and transparency and reduced average length of stay.The disadvantage of DRG is creating financial incentives toward earlier hospital discharges (Mihailovic,Kocic,& Jakovljevic,2016).

Capitated payment system is in which a doctor or hospital is paid a fixed amount per patient for a prescribed period of time by an insurer or physician association.It simplifies bookkeeping,discourages excessive billing or more costly procedures, and avoid unnecessary tests and procedures for patients.The disadvantages are providers may spend less time per patient and also incentivizes providing fewer services(Torry,T.2019).

If I were a health care czar, I would probably choose a capitated payor system. It’s the only payment system that fully aligns providers’ financial incentives with the goal of eliminating all major categories of waste. It fundamentally shifts the role of managing the amount, form, and cost of care from insurers to medical practitioners. It also ensures that providers receive enough of the savings that they can afford to fund the changes needed to bring down costs(James & Poulsen,2016).

James,B,C,.& Poulsen,G,P,.(2016).The Case for Capitation. Retrieved from .https://hbr.org/2016/

Sample Answer 2 for HCA 675 What are the pros and cons of a DRG payor system, and a capitated payor system? 

This is a great work Maggie Paul. You have succinctly defined and differentiated DRG pay and capitated pay, including their pros and cons. Indeed, it is an indication that you had a better grasp of the topic. Adding to benefits of the preferred system chosen, which is capitated pay, the system can be more efficient and simple. The reason for this is that the only requirement to focus on is the number of enrolled members (Basu, Phillips, Song, Bitton & Landon, 2017). Further, the use intricate billing codes or the involving paper works is limited. Besides, it is easier for providers to predict cash flow and patients can also easily predict health care costs.

Reference

Basu, S., Phillips, R. S., Song, Z., Bitton, A., & Landon, B. E. (2017). High levels of capitation payments needed to shift primary care toward proactive team and nonvisit care. Health Affairs, 36(9), 1599-1605.

Sample Answer 3 for HCA 675 What are the pros and cons of a DRG payor system, and a capitated payor system? 

Diagnosis-related group (DRG) is a payment system that classifies diagnoses with payment formulas that account for different weights of the groupings (Mihailovic, Kocic, & Jakovljevic, 2016). The pros include that the system should align with expected screenings, tests, and treatments for major diagnoses that are supported by clinical evidence (Mihailovic et al., 2016). This means that the DRG groups can evolve with time and expected treatment protocols of these conditions, which can set expectations for providers and health entities on reimbursement. Other pros include increased efficiency and transparency of care, as well as a reduced length-of-stay (Mihailovic, 2016). The primary con of the DRG system appears to be a financial incentivization of decreasing length-of-stay that may not be supported by research for some conditions.

The capitated payor system involves using a “fixed per person (or ‘capitated’) payment that covers all health care services over a defined time period, adjusted for each patient’s expected needs and are also held accountable for high-quality outcomes” (James & Poulsen, 2016, para. 3). The pros of this system include that it focuses on decreasing wastes and financially incentivizing providers through quality outcomes. Types of waste that it helps decrease are production-level waste, case-level waste, and population-level waste (James & Poulsen, 2016). Cons may include that it removes oversight from insurances in giving more care management responsibilities to the provider.

If I were a health care czar, I would implement a population-based, or capitated system over a DRG system. The capitated system appears to account for factors other than predetermined tests and treatments for certain diagnosis. Decreasing health care wastes and increasing quality are two primary outcomes of a population-based health care system (James & Poulsen, 2016). Shifting the responsibility of managing care to the provider will enable them to control more factors affecting care and costs. This type of system will also increase free market in the competition for patients using cost and quality as advertisement for services (James & Poulsen, 2016). I feel that this system is close to accomplishing overall goals for health care, which include controlling costs, increasing access to care, and improving quality.

References

James, B. C., & Poulsen, G. P. (2016). The case for capitation. Retrieved from https://hbr.org/2016/07/the-case-for-capitation

Mihailovic, N., Kocic, S., & Jakovljevic, M. (2016). Review of Diagnosis-Related Group-Based Financing of Hospital Care. Health services research and managerial epidemiology, 3, 2333392816647892. https://doi.org/10.1177/2333392816647892

Sample Answer 4 for HCA 675 What are the pros and cons of a DRG payor system, and a capitated payor system? 

The two major healthcare payer systems include capacitated or diagnostic related group (DRG). The DRG entails a way in which insurance companies determine the amount to pay hospitals for services offered to a patient (Davis, 2018). The system pays hospitals based on the patient’s diagnosis. The system helps the Medicare and insurance companies to save money by not paying more than what hospitals have spent. Moreover, it also reduces the length of hospital stay. A disadvantage may arise due to early discharges to enable hospitals to spend less than the DRG payment to make profits (Mihailovic, Kocic, & Jakovljevic, 2016).  It is also associated with unnecessary billings by the hospitals to maximize their profits per patient.

In the capitated payor system, hospitals are paid a fixed amount for every patient for some time by the insurance organization. It eliminates excessive billing, which allows providers to treat many patients at a lower cost (Torrey, 2018). On the other hand, the capacitation payer system makes it hard to evaluate the performance of clinicians. Also, providers tend not to take enough time to understand their patients because they want to attend to many patients (James, & Poulsen, 2016).

As a healthcare czar, I would choose the diagnostic related group payer system over capacitation based on the presented benefits of each. The DRG is associated with reduced length of hospital stay to ensure the responsive usage of resources (Reynaldos-Grandón, Saiz-Alvarez, & Molina-Muñoz, 2018). Also, the system has been proven to be efficient since it is possible to evaluate the performance of every provider. It focuses on the quality of treatment rather than the number of patients attended to.

References

Davis, E. (2018). Learn About Diagnostic Related Grouping and How It Works. Retrieved from https://www.verywellhealth.com/drg-101-what-is-a-drg-how-does-it-work-3916755

James, B. C., & Poulsen, G. P. (2016). The case for capitation. Harv Bus Rev, 94(7-8), 102-11. https://www.ncbi.nlm.nih.gov/pubmed/27526566

Mihailovic, N., Kocic, S., & Jakovljevic, M. (2016). Review of Diagnosis-Related Group-Based Financing of Hospital Care. Health services research and managerial epidemiology, 3, 2333392816647892. doi:10.1177/2333392816647892.

Reynaldos-Grandón, K., Saiz-Alvarez, J. M., & Molina-Muñoz, Y. (2018). Professional competences, clinical management and diagnostic related groups in Chilean public hospitals. Revista de Salud Pública, 20(4), 472-478. https://researchers.unab.cl/en/publications/competencias-profesionales-gesti%C3%B3n-cl%C3%ADnica-y-grupos-relacionados-

Torrey, T. (2018). Capitation Refers to a Form of a Healthcare Payment System. Retrieved from https://www.verywellhealth.com/capitation-the-definition-of-capitation-2615119