Abstract
Today’s healthcare environment in the USA is rife with talk of the “value” of care in both the public and private spheres. Understanding this dynamic is central to understanding the role return on investment (ROI) plays in the evaluation of the merit and success of quality improvement initiatives. This chapter explores the concept of value in the larger sense and begins to discuss the details of how we will consider and operationalize the financial return of quality improvement activities. We will also cover the main challenges of conducting a ROI analysis in the healthcare setting and discuss the differences between prospective and retrospective analyses.
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Notes
- 1.
More information on programs like the Quality Payment Program (QPP), the Merit-based Incentive Payment System (MIPS), and the Alternative Payment Model (APM) approach can be found at https://qpp.cms.gov/about/qpp-overview.
- 2.
This is not totally accurate: Most payers have agreements with providers so that the price charged to hospitals or clinics is lower than what would be charged to an individual paying out of pocket, as you have no doubt seen if you have ever examined a medical bill closely.
- 3.
Not to mention that there may be value to the patient in performing the test simply to rule out certain conditions or maladies, even if the course of treatment would not be altered by the test result.
- 4.
Such as in Measuring ROI in Healthcare by Victor Buzachero, Jack Phillips, Patricia Pulliam Phillips, and Zack Phillips. McGraw Hill. 2013.
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Solid, C.A. (2020). Introduction. In: Return on Investment for Healthcare Quality Improvement. Springer, Cham. https://doi.org/10.1007/978-3-030-46478-3_1
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