NUR 621 Discuss the effects the change from a retrospective cost reimbursement system to a prospective payment system has had on health care reimbursement

Grand Canyon University NUR 621 Discuss the effects the change from a retrospective cost reimbursement system to a prospective payment system has had on health care reimbursement-Step-By-Step Guide

This guide will demonstrate how to complete the Grand Canyon University NUR 621 Discuss the effects the change from a retrospective cost reimbursement system to a prospective payment system has had on health care reimbursement 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 NUR 621 Discuss the effects the change from a retrospective cost reimbursement system to a prospective payment system has had on health care reimbursement                           

Whether one passes or fails an academic assignment such as the Grand Canyon University NUR 621 Discuss the effects the change from a retrospective cost reimbursement system to a prospective payment system has had on health care reimbursement 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 NUR 621 Discuss the effects the change from a retrospective cost reimbursement system to a prospective payment system has had on health care reimbursement                         

The introduction for the Grand Canyon University NUR 621 Discuss the effects the change from a retrospective cost reimbursement system to a prospective payment system has had on health care reimbursement 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 NUR 621 Discuss the effects the change from a retrospective cost reimbursement system to a prospective payment system has had on health care reimbursement                         

After the introduction, move into the main part of the NUR 621 Discuss the effects the change from a retrospective cost reimbursement system to a prospective payment system has had on health care reimbursement 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 NUR 621 Discuss the effects the change from a retrospective cost reimbursement system to a prospective payment system has had on health care reimbursement                         

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 NUR 621 Discuss the effects the change from a retrospective cost reimbursement system to a prospective payment system has had on health care reimbursement                           

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 NUR 621 Discuss the effects the change from a retrospective cost reimbursement system to a prospective payment system has had on health care reimbursement

Re: Topic 5 DQ 1

The movement from a retrospective cost reimbursement system to a prospective payment system has had effects on health care reimbursement in different ways; and affected value-based healthcare. At the core of a prospective payment system is having a budget when the episode of care criteria are attained. As such, the Centers for Medicare and Medicaid Services (CMS) pays the provider organization to distribute to all participating clinicians (Meda et al., 2020). Conversely, a retrospective health bundled payment system requires the fee calculated before and then reconciled against fee-for-service medical claims in determining share savings after the end of the care episode.

The first effect of this change is that provider organizations must evaluate the overall cost of an episode before determining the sharing of savings as some cases may end up using more resources than budgeted and disbursed by the CMS. Secondly, it means that provider organizations using the prospective payment will apply withholds in cases where patients are later diagnosed with more severe medical conditions that require a rise in resource allocation (Eriksson et al., 2020). Thirdly, it means that payer should track fee-for-service claims against the bundled fee. This will ensure that the pricing of healthcare is based on bundled payment model but burdens the healthcare provider to ensure effective reconciliation to avoid increased costs that may never be compensated through reimbursement.

The change to a prospective payment system means that organizations offering value-based healthcare should ensure effective monitoring and tracking of all costs so that patients get compensated using the best criteria and that they do not make losses in their financial operations (Pott et al., 2023). This implies that many accountable care organizations will shy away from offering value-based health care since the prospective bundled payment approach requires several reconciliation and alignment with regulatory and legal insurance benefits design as well as claims.

References

Eriksson, T., Tropp, H., Wiréhn, A. B., & Levin, L. Å. (2020). A pain relieving reimbursement

program? Effects of a value-based reimbursement program on patient reported outcome measures. BMC Health Services Research, 20(1), 1-11. https://doi.org/10.1186/s12913-020-05578-8

Meda, I. B., Kouanda, S., Dumont, A., & Ridde, V. (2020). Effect of a prospective payment

method for health facilities on direct medical expenditures in a low-resource setting: a paired pre-post study. Health Policy and Planning, 35(7), 775-783. https://doi.org/10.1093/heapol/czaa039

Pott, C., Stargardt, T., & Frey, S. (2023). Does prospective payment influence quality of care? A

systematic review of the literature. Social Science & Medicine, 115812. https://doi.org/10.1016/j.socscimed.2023.115812

Sample Answer 2 for NUR 621 Discuss the effects the change from a retrospective cost reimbursement system to a prospective payment system has had on health care reimbursement

Healthcare reform becomes a balance between providing access to patients, reducing the cost of healthcare, and providing the best quality of care so patients experience the best outcomes. Healthcare is changing from a retrospective cost reimbursement system (fee for service) to a prospective payment system, whereas payment is based on a predetermined, fixed amount. Value-based payment, pay for performance, value-based reimbursement, value-based care, and value-based programs are commonly used interchangeably (Daub et al., 2020). A prospective payment system (PPS) is where the payer (Medicare, Medicaid) decides the costs of care prior to any care being provided. Hospitals under a PPS are paid a set amount, no matter the number of resources used to provide the service or the level of care (acute care, intensive care, etc.) (Leger, 2021). The PPS keeps the cost of healthcare under control for the insurer and lowers the cost for the consumer. Changes from volume-based care to a value-based reimbursement system allow providers to receive reimbursement based on the quality rather than the quantity of care provided (Leger, 2021). The importance of value-based care relates to patient-reported experience, clinical and patient-reported quality of life outcomes (Harrison, 2022). Examples of healthcare quality outcomes include patient mortality, hospital readmissions, and patient length of stay.

Nurse leaders must understand this reimbursement change to empower their teams to be focused on providing great patient care, improving the patient experience, utilizing clinical practice guidelines, and the effectiveness and efficiency of care and outcomes for patients (Harrison et al., 2022). The writings of May et al., 2020 remind leaders how these reimbursement changes involve staff outcomes as well. Ensuring their units demonstrate an excellent culture and positive staff engagement, reducing staff turnover, staff burnout, and increasing staff retention. Examples of healthcare quality outcomes include patient mortality, hospital readmissions, and patient length of stay.

References:

Daub, S., Rosenzweig, C., & Schilkie, M. C. (2020). Preparing for a value-driven future. Families, systems & health: The Journal of Collaborative Family HealthCare, 38)1), 83-86. https://doi-org.lopes.idm.oclc.org/10.1037/fsh0000476.

Harrison, R., Manias, E., Ellis, L., Mimmo, L., Walpola, R., Roxas-Harris, B., Dobbins, T., Mitchell, R., Cowie, S., Maberly, G., Chan, C., & Hay, L. (2022). Evaluation clinician experience in value-based health care: the development and validation of the clinician experience measure (CEM). BMC Health Services Research, 22(1), 1-10. https://doi-org.lopes.idm.oclc.org/10.1186/s12913-022-08900-8

Leger, M. (2021). Financial management for nurse managers: Merging the heart of the dollar (5th ed.). Jones and Bartlett. ISBN-13: 9781284230932

May, N., Start, R., Ferkey, K., Allard, B. L., & Randazzo, G. (2021). Preparing Nurse Leaders for Value-Based Care: A Toolkit to Guide Practice Transformation. The Journal of Nursing Administration, 51, 355-358. https://doi.org/10.1097/NNA.0000000000001027