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Departmental Impact on Reimbursement In an essentially applied area of research, there are particular pressures on health services and policy researchers to describe the impact of their work. However, specialized research impact assessments often require skills and resources beyond those available to individual researchers, and ad hoc accounts impose a considerable burden to generate. Further, these idiosyncratic accounts may not facilitate comparative analysis to inform research management, practice and assessment. A Research Impact Framework was developed, drawing on the literature and interviews with researchers at the London School of Hygiene and Tropical Medicine, and was used to structure impact narratives of selected research projects. These narratives were based on semi-structured interviews with principal investigators and documentary analysis of the projects.Using the framework as a guide, researchers were relatively easily and methodically able to identify and present impacts of their work. Researchers' narratives contained verifiable evidence and highlighted a wide range of areas in which health services and policy research has impact. The standardized structure of the narratives also facilitated analysis across projects. Factors thought to positively influence the impact of research included researchers' continued involvement in research and policy networks, established track records in the field, and the ability to identify and use key influencing events, such as 'policy windows'. The framework helped develop research impact narratives and facilitated comparisons across projects, highlighting issues for research management and assessment.A corporate compliance program can prevent both intentional and accidental wrongdoing and can be viewed positively by investigators and the courts, often reducing civil or criminal penalties. The mere existence of a compliance program, however, does not excuse any corporation of wrongdoing. In fact, a poorly planned and executed compliance program can be viewed worse than having no compliance program at all. Health care providers need to address many of the same compliance concerns as their corporate counterparts. In addition to the laws and regulations already in existence, health care providers face continuing enforcement initiatives from the Centers for Medicare & Medicaid Services (CMS), the Office of Inspector General (OIG), the United States Department of Justice (DOJ), and various national and state accreditation bodies. A health care provider’s compliance program will consist of various policies and standards and will vary depending on the specific entity. Generally, corporate compliance programs include policies and procedures designed to define and identify laws and regulations, correct identified problems, and put controls in place to prevent future problems. Pay-for-performance has become popular among policy makers and private and public payers, including Medicare and Medicaid. The Affordable Care Act expands the use of pay for-performance approaches in Medicare in particular and encourages experimentation to identify designs and programs that are most effective. This policy brief reviews the background and current state of public and private pay for-performance initiatives. In theory, paying providers for achieving better outcomes for patients should improve those outcomes, but in actuality, studies of these programs have yielded mixed results. Pay-for-Performance is great systems that reward doctors and hospitals for improving the quality of care, but studies to date show mixed results. Pay-for-performance programs can also impose financial penalties on providers that health policy brief pay-for -performance 2 fail to achieve specified goals or cost savings.For example, the Medicare program no longer pays hospitals to treat patients who acquire certain preventable conditions during their hospital stay, such as pressure sores or urinary tract infections associated with use of catheters. The quality measures used in pay-for performance generally fall into the four categories which will be the Process, Outcome, Patient experience and Structural measures. Most early pay-for-performance experiments narrowly focused on “quality” with very little, if any, consideration of cost. However, the field has been evolving and many programs now address overall value by incorporating both quality and cost as major design elements. Health care’s regulatory audit front has never been noisier. In fact, there’s palpable acrimony toward acronyms. From MACs and RACs to CERT and the ever-present reach of HIPAA and the Centers for Medicare & Medicaid Services (CMS), HIM departments and hospitals executives must be on guard at all times to avoid the fallout of penalties. Keeping up with the current compliance challenge and staying one step ahead of new regulations and requirements isn’t for the faint of heart. And while there’s sufficient reason for HIM departments to feel some anxiety about having the CMS knock on their door, most professionals agree that the best defense is to go on the offensive.Health care organizations that successfully navigate compliance know that it takes a combination of proactive governance and solid internal auditing programs to achieve positive results.Referenceshttps://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_78.pdf http://www.fortherecordmag.com/archives/0314p18.shtmlhttp://library.ahima.org/doc?oid=58837#.WCxJYKQUWM8
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