Hospital Acquired Conditions With Respect to Value- Based Purchasing and Payback Payment Systems

Yıl 2015, Cilt: 2 Sayı: 3, 155 - 164, 01.08.2015

Mehmet Nurullah Kurutkan Murat Bayat

Öz

AbstractThe main objective of this study is to show the fact that Hospital Acquired Conditions (HAC) could be subject to Value-Based Purchasing (VBP) system. The secondary objective is to propose a Value Based Purchasing (VBP) system to The Social Security Institution of Turkish Republic (SGK) in the light of USA’s practices. Initially, the conceptual framework of VBP and HAC are to be defined. The need for VBP system, different applications and practices among the States in USA, main reasons of HAC and the situation in Turkey with regards to HAC will be assessed within the frame work of Turkuaz Standards. Finally, a policy development approach to this system is to be proposed to the policy makers in order initiate this system in Turkey.

Anahtar Kelimeler

Hospital Acquired Conditions, Value Based Purchasing System, Turkuaz Standards, Payback Payment system.

Değer Bazlı Satın Alma ve Geri Ödeme Sistemi Açısından Hastane Kaynaklı Durumlar

Öz

OzetBu çalışmanın temel amacı, gelişmiş ülke uygulamaları bağlamında hastane kaynaklı durumların (HKD) değer bazlı satın alınmaya (DBSA) konu olabileceğini göstermektir. Özellikle ABD uygulaması ışığında Sosyal Güvenlik Kurumu’nun (SGK) faydalanacağı DBSA program önerisi geliştirmek tali amacımızdır. Öncelikle DBSA ve HKD’ın kavramsal çerçevesi çizilecektir. DBSA’ya neden ihtiyaç duyulduğu, eyalet sistemlerine göre değişiklik gösterip göstermediği, HKD kavramının temel beslenme kaynaklarının ne olduğu ve HKD açısından Türkiye’de mevcut durumun ne olduğu Turkuaz standardı açısından değerlendirilecektir. Nihai olarak politika yapıcılar için arzu edilirse nerden başlanması gerektiğine dair bir politika geliştirme önerisi sunulacaktır.

Anahtar Kelimeler

Hastane Kaynaklı Durumlar, Değer Bazlı Satın Alma, Turkuaz Standardı, Geri Ödeme Sistem

Kaynakça

• “12 Modül Broşürleri”, Sosyal Güvenlik Kurumu Genel Sağlık Sigortası Müdürlüğü Yayınları http://turkuazstandart.org.tr/ kategori/3/12-turkuaz-brosur 21.11.2014 tarihli erişim
• “Turkuaz Sağlık Bakımı Kalite Standardı Sözlüğü”, (2014), Çıktı Odaklı Sağlıkta Kalite Standardı”, Sosyal Güvenlik Kurumu Genel Sağlık Sigortası Müdürlüğü Yayınları Sözlüğü http://turkuazstandart.org.tr/upload/cikti_odakli_sozluk_ www.pdf 21.11.2014 tarihli erişim
• “Turkuaz Standart Sağlıkta Kalite Standardı”, (2014) Sosyal Güvenlik Kurumu Genel Sağlık Sigortası Müdürlüğü Yayınları http://turkuazstandart.org.tr/upload/ciktiodakli_ saglikta kalite_www.pdf 21 11 2014 tarihli erişim
• http://turkuazstandart.org.tr/kategori/3/12-turkuaz-brosur (12 Broşür için) 21.11.2014 tarihli erişim
• Grace M. Lee, M.D., M.P.H., Ken Kleinman, Sc.D., Stephen B. Soumerai, Sc.D., Alison Tse, Sc.D., David Cole, B.M., Scott K. Fridkin, M.D., Teresa Horan, M.P.H., Richard Platt, M.D., Charlene Gay, B.A., William Kassler, M.D., M.P.H., Donald A. Goldmann, M.D., John Jernigan, M.D., and Ashish K. Jha, M.D., M.P.H. (2012), Effect of Nonpayment for Preventable Infections in U.S. Hospitals N Engl J Med 2012;367:1428-37.
• Health Care Purchaser Toolkit: HOSPITAL-ACQUIRED CONDITION PAYMENT POLICY (2009) Developed for NBCH by: www.discernconsulting.com 410-542-4470
• Hospital-Acquired Conditions (HAC) in Acute Inpatient Prospective Payment System (IPPS), (2012) Hospitals Department of Health and Human Services Centers for Medicare & Medicaid Services 2012 ICN 901045 October 2012 http://www.cms.gov/HospitalAcqCond, 21.11.2014 tarihli erişim
• http://www.cms.gov/HospitalAcqCond 26.11.2014 tarihli erişim
• Institute of Medicine, To Err is Human: Building a Safer Health Care System (Washington, D.C.: National Academy Press, 1999), 26.
• Keckley, P., Coughlin, S., & Gupta, S. (2011). Value-Based Purchasing: A Strategic Overview for Health Care Industry Stakeholders. Deloitte Center for Health Solutions. http:// www. deloitte. com/assets/Dcom-UnitedStates/Local% 20Assets/ Documents/ Health%20Reform%20Issues%20 Briefs/US_CHS_ValueBasedPurchasing_031811.pdf. Deloitte, 26.11.2014 tarihli erişim
• LaBresh Kenneth A, MD Jarrett Nicole, MSPH Lux Linda, MPA CMS Project Officer: Radey Linda A., PhD (2012) Evidence-based Guidelines for Selected and Previously Considered Hospital-Acquired Conditions Report Update RTI International 3040 Cornwallis Road Research Triangle Park, NC 27709 RTI Project Number 0209853.231.00
• Miltenberger, Barbara; Blackwell Husch, City Jefferson, Downs Sarah, Blackwell Husch; (2012), Value-Based Purchasing—What’s Ahead for Healthcare Providers AHLA Connections, (Amerikan Health Lawyers Association) February ss: 16-22 www.healthlawyers.org 25.11.2014 tarihli erişim
• National Quality Forum (NQF). Safe Practices for Better Healthcare–2009 Update: A Consensus Report. Washington, DC: NQF; 2009.
• National Quality Forum (NQF). Serious Reportable Events in Healthcare 2006 Update: A Consensus Report. (Washington, D.C.: NQF, 2007), vi.
• Rosenthal, Jill and Hanlon, Carrie, Nonpayment for Preventable Events and Conditions: Aligning State and Federal Policies To Drive Health System Improvement December 2009 www.nashp.org 26.11.2014 tarihli erişim
• Snow, Catherine. L., MPH Linda Holtzman, MHA Hugh Waters, PhD Nancy T. McCall, ScD Michael Halpern, MD Lisa Newman, MSPH John Langer, PhD Terry Eng, MS Carolyn Reyes Guzman, MPH Federal Project Officer: Susannah G. Cafardi (2012) Accuracy of Coding in the Hospital-Acquired Conditions–Present on Admission Program Final Report, RTI International 3040 Cornwallis Road Research Triangle Park, NC 27709
• National Strategy for Quality Improvement in Health Care, (2011), Department of Heath and Human Services, Report to Congress: (Mar. 2011), s. 9, www.healthcare.gov/law/ resources/reports/quality03212011a.html
• “Medicare Hospital Value-based Purchasing Plan Development,” Issue Paper, U.S. Department of Health & Human Services, 1st Public Listening Session, January 17, 2007, https://www.cms.gov/AcuteInpatientPPS/downloads/ hospital_VBP_plan_issues_paper.pdf
• Shoemaker, Paul, (2011), What Value-Based Purchasing Means To Your Hospital, Healthcare financial management: Journal of the Healthcare Financial Management Association, 65(8), 60-68.