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The Good Samaritan Society continues to expand post-acute care while striving to deliver excellent care that is affordable. The Society is testing various Alternative Payment Models (APMs) to achieve that goal.
Two primary Alternative Payment Models are: Accountable Care Organizations (ACOs) and Episode-Based Payment Initiatives (Bundled Payments).
The CMS Innovation Center was created as part of the Affordable Care Act.
Congress established the Innovation Center to test new payment and care delivery models and to reduce program costs, while maintaining or improving the quality of care for people who receive Medicare, Medicaid or Children’s Health Insurance Program (CHIP) benefits.
ACOs are groups of doctors, hospitals, and other healthcare providers, who come together voluntarily to give coordinated high-quality care to the Medicare patients they serve. This coordinated care helps ensure that patients, especially the chronically ill, get the right care at the right time, avoid unnecessary duplication of services, and prevent medical errors.
When an ACO succeeds in both delivering high-quality care and spending healthcare dollars more wisely, it will share in the savings it achieves for the Medicare program.
Traditionally, Medicare makes separate payments to providers for each individual service they provide for a single illness or course of treatment. This method rewards the quantity of services offered by providers rather than the quality of care furnished.
Research has shown that bundled payments can align incentives for providers, allowing them to work closely together across all specialties and settings to help lower costs and improve patient outcomes.
In each of these payment models, the CMS Innovation Center provides feedback to providers who participate in order to support continuous quality improvement.
The CMS Innovation Center understands that learning and adaptation are essential to achieve the greatest improvements possible in each new payment model. It also leverages claims data to deliver actionable feedback to providers about their performance, and encourage them to use that performance data to drive continuous improvement in their outcomes.
Grant funding is available to help our medical directors achieve AMDA Medical Director Certification. Click here to learn more and apply for funding.
Click here to download instructions to access your AMDA membership.
Click here to download a copy of our medical provider guidelines.
Quality Assurance and Performance Improvement, or QAPI, is a framework to guide work in quality and performance improvement.
The Good Samaritan Society believes that QAPI is the right thing to do because the structure it provides helps move us away from simply meeting minimal standards toward continuous quality improvement.
There are five strategic elements that form the framework for QAPI. Medical directors play a role in each of the five elements.
Residents should only receive those medications necessary to treat their conditions. Any drugs used should generally be:
The resident’s provider (physician, nurse practitioner [NP] or physicians’ associate [PA]) should explain the intended benefit(s) of every drug — individually or in combination with others — and the likely or possible risks associated with using them.
Every medicine has potential associated risks. It is impossible to discuss all risks, so we provide educational materials for many medicines.
It is important that you agree that the intended benefits outweigh the potential risks.
For some drugs, particularly those used for behaviors, you will be asked to sign a “Risk/Benefit Statement” signifying that you understand why the drug is being recommended and the potential risks of its use.
You are encouraged to ask questions and only sign the document when you feel comfortable that the drug is worthwhile. Although you may not demand that a particular medication be used, you always have the right to refuse to have the resident take any medication.
Please feel welcome to ask other professionals in the facility to provide more information in this area, especially the medical director, pharmacist and nursing staff.
Thank you for helping us provide the best care possible for our residents!
Click the links below to download patient information materials.