Healthcare Quality Improvement: Core Measures, Reimbursement Analysis

This report examines the critical relationship between core measures and reimbursement in healthcare, emphasizing the importance of achieving core measures to improve patient outcomes and maintain motivated healthcare providers. It discusses the potential consequences for organizations that neglect core measures, including negative impacts on patient health and organizational performance. Furthermore, the report explores the connection between value-based reimbursement and core measurement compliance, highlighting how value-based care can enhance compliance and improve patient health outcomes. The report also touches on the challenge of patient awareness regarding core measures. Desklib provides access to similar solved assignments and past papers for students.

Running head: HEALTHCARE QUALITY IMPROVEMENT
Healthcare Quality improvement
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1Healthcare Quality improvement
Exlore the Relationship between demonstrating successful achievement of the core measures
and reimbursement
Core measures are the measures defined by the healthcare authorities of the Centers for
the Medicare and Medicaid Services and joint commission to promote best patient care and
enhance the patient outcome (Pearson et al., 2016). Core measures are the national values of the
care and the conduct for the general condition. It helps in providing better patient care by
reducing the health complication of the patient and assist in enhancing the patient outcome. In
the nursing field, core measures are defined as the evidence based standards of the patient care
which was established by the Centers for Medicare and Medicaid Services and joint commission.
Core processes are mainly practiced in the clinical areas such as, heart failure, acute myocardial
infraction and other severe disease (Pearson et al., 2016).
Core measures are said to be achieved in an organization, if the health condition of the
patient are improved and the adverse health outcomes are reduced. Reimbursement is described
as the patient which the doctors, hospitals and the healthcare staff receives in order to provide
better care and enhanced medical service to the patient. There is a direct connection amongst the
effective achievement of the core measures and the compensation (Wilkinson & Boyd,2017).
If the healthcare providers are reimbursed, they will stay motivated in their workplace
which will eventually have positive consequence on the patient care. If the general practitioner
and the other health care provides will stay motivated regarding their work, there are more
chances in having aefficacious accomplishment of core measures. Their are less cahnces that
they will leave their job as well also contribute in achiveing the core measures by providing
enhanced patient care. Hence, it can be stated that the achievement of the core measures and the
reimbursement are related to each other.

2Healthcare Quality improvement
What is the future of organizations and providers who do not focus on core measures?
Core messures are defined as the maesures which if implied in an health care
organization it can laed to better patient care and quick recovery. In order to do that, it is
extremely important for the healthcare providers to focus on the core measures to enrich the
eminence of the patient care and to enhance the patient care and treatment to the patient suffering
from severe disease such as, heart failure. Sometimes it is observed that the core measures are
not followed in an organization which leads to negative impact on the health of the patient as
well as on the organization. If in an organization it is observed that the providers do not actually
focuses on the core measures (Pincus et al., 2016). Absence of core measures in an organization
prevents the promotion of the measurement which helps in the generation of the appropriate
information and also helps in the evidence based method to enhance the quality improvement. if
the providers do not actually focuses on the core measures, it might affect the consumer decision
making and the value based purchasing and the payment. Hence, it can be stated that if in any
orgnization core measures are not follwed, health of the patient hampers who has been suffering
from severe disease and illness.
Theconnection between value-based reimbursement and core measurement compliance:
Value based reimbursement is defined as the value based care which collaborates the
payment to the care delivery in an organization to the quality are that has been provided and the
rewards are provided to the carers for both the effectiveness and the efficacy (Manary et al.,
2015). Core measurement compliance is defined as the effectiveness of the treatment in the
hospitals. It show that each and every recommendation for the treatment of the specific medical
condition (Layton, 2016). There is a connection observed between the value-based

3Healthcare Quality improvement
reimbursement and the core measurement compliance. Value based reimbursement helps in the
enhanced core measurement compliance.
In order to do that it is important that the organization should be measures with the core
measures which can be identified by assessing the patient health outcomes. Patient health
outcomes can be reported by help of various tests. It is observed that the achievement of the core
measurement is equal to the values such as it helps in improving the health condition of an
individual as well as enhances the outcome. The consumers or the patient are not well aware of
the core measures which can sometimes act a hurdle in the patient care (Goldman et al., 2016).

4Healthcare Quality improvement
Reference:
Goldman, M. L., Spaeth-Rublee, B., Nowels, A. D., Ramanuj, P. P., & Pincus, H. A. (2016).
Quality measures at the interface of behavioral health and primary care. Current
psychiatry reports, 18(4), 39.
Layton, T. P. (2016). Information Security: Design, implementation, measurement, and
compliance. Auerbach Publications.
Manary, M., Staelin, R., Boulding, W., & Glickman, S. W. (2015). Payer mix & financial health
drive hospital quality: Implications for value-based reimbursement policies. Behavioral
Science & Policy, 1(1), 77-84.
Pearson, D., Benson, A., Blanset, J., & Lovett, K. (2016). 1422: COMMON REASONS CORE
MEASURES ARE NOT MET IN PATIENTS WITH SEVERE SEPSIS AND SEPTIC
SHOCK. Critical Care Medicine, 44(12), 431.
Pincus, H. A., Scholle, S. H., Spaeth-Rublee, B., Hepner, K. A., & Brown, J. (2016). Quality
measures for mental health and substance use: gaps, opportunities, and challenges. Health
Affairs, 35(6), 1000-1008.
Wilkinson, C. J., & Boyd, E. H. (2017). Bridging the Gap between Academia and Practice in
Service Excellence and Core Quality Measures.