High Value Care

High Value Care

The following are different examples of how you can learn more about high value care. You can pick one or be creative and come up with your own reflections on your patients’ experiences, charges, and how/ whether HVC practiced. Most of these would work well to do with members of your “teamlet” and make a group submission.

To complete options 1-3, UF Health patients must sign the healthcare cost authorization form in order to obtain a copy of their hospital charges. Contact Mary Delaplaine (265-0371) delapm@shands.ufl.edu   and give her the patient’s DOB or MR# so she can have the charges pulled and tell you when to pick them up. You will take the authorization form to Admissions on the first floor of the north tower and exchange that for the charges. The VA does not give out charges but you may use the following resources to estimate charges. http://healthcarebluebook.com/ or http://clearhealthcosts.com/

  1. Review a Patient’s Bill with the PCRM

Description: Obtain a copy of the itemized charges for your patient’s stay and review them with the PCRM to learn about the DRG reimbursement and how much your patient will have to pay. The purpose of this exercise is to acquaint you with the charges for common medical tests, medications, hospital rooms, etc., to give you insight into why lengths of stay are shortening, and to help you understand how hospitals are reimbursed for patient care.

Submission criteria: Describe what you learned from this in 1-2 paragraphs including whether/how you think reimbursement and its relationship to length of stay affected the quality of care for your patient. Submitting the actual (HIPAA compliant!) itemized charges is optional.

2. Reflect of Necessity of Patient Orders

Description: Analyze your* ordering practices of labs, x-rays, and other tests for one of your patients and calculate the approximate cost. In retrospect, reflect on whether all these tests were really necessary (e.g. did they change management) and if not, estimate the potential cost savings to your patient. (Include adverse outcome “costs” as well as monetary.) Conversely, you can analyze whether potentially helpful tests were withheld possibly due to reimbursement/cost issues.

*I realize you do not have primary responsibility for deciding which tests are ordered. That is OK as it will allow you to compare what you would have done vs. your team.

Submission criteria: Briefly summarize your reflections about what you learned. Submitting the actual (HIPAA compliant!) itemized charges is optional.

3. Learn About Different Insurance Coverage

Description: Pick 1-2 days of one of your patient’s hospital stay and calculate the anticipated charges (e.g. fee for the room, tests, medicines, doctor fees, etc.) and compare the coverage that would be provided if the patient had Medicare, Medicaid, or BC/BS and how much the hospital is reimbursed for each of these. The PCRMs and coders are potential resources to help with this. (The two HVC modules on insurance may be a helpful resource.)

Submission criteria: Provide a brief summary of what you learned and whether/how you think these insurance differences might affect the quality of care. Submitting the actual (HIPAA compliant!) itemized charges is optional.

4. Reflect on the HVC Modules

Description: All students are required to complete HVC modules 1 and 5. There are 12 modules, 8 relevant to adult medicine. You are encouraged to complete al the adult modules 1-6, 9, & 12.

Optional Submission: Provide a brief reflection  on the take home messages you learned form the modules you completed and whether/how they affected your patient care and upload to Canvas.