Quality Metrics Assignment

Quality metrics are used in healthcare are used to examine the quality of care in order to ensure high-quality care and ensure cost-effective healthcare. Two metrics at WellMed Medical Management include The Pink Box Report and star rating. The Pink Box Report is a type of dashboard used to track the rank and status of all recommended preventative care interventions, screening, and quality metrics for all patients at WellMed (Windh, 2016).  Primary care providers are provided with the report as a spreadsheet indicating each panel member, and the rank on all measures. Primary care providers are supposed to reach out to their patients, book appointments, and complete all the appropriate activities for a year. Primary care providers are awarded bonuses according to the panel members and how best they address gaps in care. This ensures that healthcare providers provide high-quality care by ensuring effective and optimal provision of office visits, preventative care intervention, and screening of WellMed patients (Windh, 2016). A five-star rating is also used to rate and measure the quality of provided services. The health plans and healthcare services are rated on a scale of 1-5 stars, where the rating of 5 is the highest. A rating of 5 stars indicates that the health plans and services are of high quality, while a rating of 1 indicates poor quality (Ryskina et al., 2018). The rates are finally shared with all healthcare providers in the organization. Sharing of the results allows healthcare providers to improve on services and metrics having low quality, ensuring a better provision of care and other services.

References

Ryskina, K. L., Konetzka, R. T., & Werner, R. M. (2018). Association Between 5-Star Nursing Home Report Card Ratings and Potentially Preventable Hospitalizations. Inquiry: a journal of medical care organization, provision, and financing, 55, 46958018787323. https://doi.org/10.1177/0046958018787323

Windh J. (2016). Key Components for Successful LTSS Integration: Case Studies of Ten Exemplar Programs. WellMed.

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Identify two quality metrics used in your clinical workplace. How are these measured and are the results shared with the nursing staff? If not, do you think they should be? What would be the benefit?
I live in el Paso, Texas
I work in a Managed Care organization. I look at Hierarchical Condition Category coding (HCC codes) and proper documentation for accurately diagnosing and reimbursement. More specifically, I work for WellMed Medical Management. I am a clinical nurse coding consultant.
Please if you can use resources in attachment.

DOI: 10.1097/00115514-201601000-00011

The Capital Budgeting Process of Healthcare Organizations: A Review of Surveys.

 

(Mukherjee, Al Rahahleh, Lane, & Dunn, 2016)

References

Mukherjee, T., Al Rahahleh, N., Lane, W., & Dunn, J. (2016). The capital budgeting process of healthcare organizations: A review of surveys. Journal of Healthcare Management, 61(1), 58-77. doi:10.1097/00115514-201601000-00011

 

ECONOMICS AND FINANCIAL MANAGEMENT for Nurses and Nurse Leaders Third Edition

ISBN: 978-0-8261-6001-0

(Penner, 2017)

References

Penner, S. J. (2017). Economics and financial management for nurses and nurse leaders. New York, NY: Springer Publishing Company, LLC.

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Budget training: It’s overdue

Contino, Diana S. Nursing Management; Chicago Vol. 32, Iss. 8,  (Aug 2001): 16-7. DOI:10.1097/00006247-200108000-00006

(Contino, 2001)

References

Contino, D. S. (2001). Budget training: It’s overdue. Nursing Management, 32(8), 16-7. doi:http://dx.doi.org.lopes.idm.oclc.org/10.1097/00006247-200108000-00006

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