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E. Rey Garcia, MPA Candidate Public Policy Formulation August 10, 2015 Budgeting: Allocation & Public Policy Final Assignment #7 A Summary, Analysis, & Recommendations, the Federal Budget Process and Public Policy

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Page 1: Budgeting: Allocation & Public Policy, A Summary, Analysis, & Recommendations

E. Rey Garcia, MPA Candidate

Public Policy Formulation

August 10, 2015

Budgeting: Allocation & Public Policy

Final Assignment #7

A Summary, Analysis, & Recommendations, the Federal Budget Process and Public Policy

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Final Assignment

Budgeting: Allocation & Public PolicyA Summary, Analysis, & Recommendations, the Federal Budget Process and Public Policy

By: E. Rey Garcia, MPA CandidateMonday, August 10, 2015

**************

The University of Texas Rio Grande Valley (UTRGV)The Graduate College

Public Affairs-Administration

*************

PUBA 6311: Public Policy FormulationSummer 2015, Module 2

Dr. Atisa

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Table of Contents

Objective 6

Introduction 6

Summary 6

The Characteristics of the Federal Budget 6

Executive Budget 7

The Line Item 7

Annual Budget 7

The Budget Cycle 8

Setting the Parameters: The President and His Friends 9

The Agency Requests 9

Executive Review 9

Congressional Action 10

Budget Execution 11

Budget Control 11

Problems in the Budget Process 12

The Deficit 12

Uncontrollable Expenditures 12

Supplemental Appropriations 13

Earmarks 13

The Rebirth of Program Budgeting 16

Analysis 17

Resources/Money 17

Working with and around the Deficit and the National Debt 18

The Top-Five Elements of the Budgeting Process 18

Concluding Recommendations – Performance Measurement 23

References 25

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Objective

To brief, educate, and mentor the candidate on the Characteristics of the Federal Budget,

the Executive Budget, Line Items, the Annual Budget, the Federal Budget Cycle and the

allocation of funds and any obstacles, issues or problems associated with the process.

Introduction

This case study defines the processes and steps that a recent MPA graduate, who was

hired as a campaign manager for a Congresswoman from a conservative Republican and

Democratic district with two large cities and a large rural population with a vast majority of

senior citizens. The primary task of the campaign manager is to brief, educate, and mentor the

Congresswoman on the Federal Budget Process and the allocation of funds, as it applies to

Public Policy.

Summary

I. The Characteristics of the Federal Budget:

The Federal Budget has several fundamental features that are in some ways not only

beneficial to decision makers but also serve to constrain them and at times help create

undesirable outcomes. The Federal Budget is not politically neutral, however, it directly

affects the outcomes of the process. The frequent attempts to adjust and reform comes

with budgetary resistance from the stakeholders, thus, causing political debating that ends

up in compromising and negotiating before it is approved.

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a. Executive Budget - The federal budget is an executive budget, prepared by the

president and his staff, approved by Congress, and then executed by the president

and the executive branch. That has not always been the case. Before 1921, the

federal budget was a legislative budget, prepared almost entirely by Congress and

then executed.

The Budget and Accounting Act of 1921 – Prior to 1921, the Federal Budget

was a Legislative Budget and was prepare by Congress. The Budgeting and

Accounting Act of 1921 added to the existing conflict between the executive and

legislative branches over budgeting powers. Budgetary power has accumulated in

the executive branch and in the Executive Office of the President, in large part

because of the analytical dominance of the Office of Management and Budget

(OMB; it was called the Bureau of the Budget until 1971).

b. The Line Item - The Federal Budget remains a line-item budget. That is, the final

budget document allocates funds into categories such as wages and salaries,

supplies, travel, equipment, and so forth for specific purposes within an agency.

Input controls are now considered inefficient means of control over public

organizations and their managers. Critics have argued that it would be better to

give a manager a relatively unrestricted budget and judge him afterwards.

c. Annual Budget - The Federal Budget is primarily an annual budget. Agencies

now must submit five-year forecasts for each of their expenditures and they are

used primarily for OMB’s management purposes. The budget presented to

Congress and the appropriations bills that Congress eventually adopts together

constitute only a one-year expenditure plan.

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II. The Budget Cycle:

Fiscal Year 2014 U.S. Federal Spending – Cash or Budget Basis. The Budget of the

United States Government often begins as the President's proposal to the U.S. Congress

which recommends funding levels for the next fiscal year, beginning October 1. Fig 01,

shows the step-by-step cycle and process for adopting the Annual Federal Budget.

Fig. 01: The Annual Federal Budget Process

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a. Setting the Parameters: The President and His Friends – The spring review is

the first official act of the budget cycle is the development of estimates of the total

size of the federal budget to be prepared for the fiscal year. Agencies and OMB

have already have begun to discuss and prepare expenditure plans and a letter

from the president to OMB (Circular A-11, usually issued in June) is an important

first step in the formal process, providing a statement of overall presidential

budgetary strategy and of the financial limits within which agencies should begin

to prepare their budgets. Setting overall parameters in the letter present details on

individual agencies.

b. The Agency Requests – When it comes to U.S. policymaking, government

agencies are central actors in the budget process. Whether independent or within a

cabinet-level department, the agency is responsible for the initial preparation of

estimates and requests for.

c. Executive Review – Once agencies decide on the requests, it is passed to the

presidential agency, the Office of Management and Budget (OMB) for review.

OMB’s task is to gather all agency requests and conform them to presidential

policy priorities for overall expenditure-levels desired.

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d. Congressional Action - The Constitution grants it the powers of the purse, by the

1960s and 1970s, Congress has ceased to be dominating budgetary decision-

maker.

The Congressional Budget and Impoundment Control Act of 1974 –

According to Congress.gov, the Congressional Budget and Impoundment Control

Act of 1974, sets forth the definitions of terms used in the Act:

Title I: Establishment of House and Senate Budget Committees= - Establishes a

Standing Committee of the Senate to be known as the Committee of the Budget.

Establishes such a Committee of the House. Outlines the composition and duties

of the committees. Provides that each such committee shall make a continuing

study of the effects of budget outlays and devise methods of coordinating tax

policies with budget outlays.

Title II: Congressional Budget Office= - Creates a Congressional Budget Office

and outlines the duties of such Office. States that the function of the Office is to

provide information to the Budget Committees of the two Houses and to other

Committees of the two Houses with respect to the budget, appropriation bills, and

other bills providing budget authority or tax expenditures.

It abolishes the Joint Committee on Reduction of Federal Expenditures. Provides

for public access to budget data.

(Source: https://www.congress.gov/bill/93rd-congress/house-bill/7130.)

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e. Budget Execution - Once Congress appropriates the funds for the executive

branch, agencies must develop mechanisms and plans for spending the allocated

funds. An appropriations warrant, drawn by the Treasury and countersigned by

the Government Accountability Office, is sent to each agency. Agencies make

plans for expenditures for the year and base it on the warrant and submits a plan

to OMB for apportionment of the funds. Funds appropriated by Congress are

made available on a quarterly basis, but for some agencies, there may be great

differences in the amounts for each quarter.

f. Budget Control – Once the executive branch spends the approved funds,

Congress verifies, checks and audits the expenses to make sure they are legal.

g.

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III. Problems in the Budget Process:

The Federal Budget Process is a lengthy one, taking as up to eighteen months to approve

a complexity of negotiations of back and forth debate amongst the competing agencies.

The process involves substantial bargaining and analysis, from which emerges a plan for

spending billions of dollars.

a. The Deficit – According to False Economy, is the gap between what the

government spends and what it gets in income, mainly from taxes. Big deficits

are inevitable in a recession. Spending goes up to pay extra unemployment

benefits. Tax income falls. Companies make smaller profits or

even fail. (Source: http://falseeconomy.org.uk/cure/what-is-the-deficit).

The importance of the deficit during the election process and debates. The deficit

has been a major force driving budget reform in the United States, because of the

negative and debts it symbolizes. Politicians need to remain concerned and aware

of their charges of fiscal irresponsibility. Because of the ideological baggage

associated with deficit and debt, it has been difficult at times to discuss them

rationally.

b. Uncontrollable Expenditures – Most of the Federal Budget is uncontrollable in

any one year. Most federal spending programs cannot be controlled systematically

without making policy changes that would be politically unpalatable. With Social

Security, Medicare and unemployment benefits being the most important

uncontrollable expenditures in the Federal Budget.

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c. Supplemental Appropriations – To cover any shortfalls, agencies may also

require supplemental appropriations to be made outside the normal budget cycle.

Oftentimes, due to poor budget management or demands of services, agencies

sometimes run out of money. Agencies can often request that a program be

approved with minimal appropriations to gain popular vote and support, however,

the agencies can then use strategies to attempt to expand funding once the

program and funds have been allocated and approved, followed by the agencies

anticipation that by returning to Congress for supplemental appropriations when

clients materialize and demand benefits.

d. Earmarks - These are funds provided by Congress for projects or programs that

curtail the ability of the Executive Branch to manage critical aspects of the funds

allocation process.

The following table summarizes preliminary earmark counts and amounts by

Appropriations Subcommittee for FY 2010 as earmarks move through the

legislative process to become law. By clicking on the links below, you can browse

available earmark data by agency. The data includes total counts, amounts (in

thousands), and listings of earmarks with descriptions, funding by stage,

congressional sponsors, and supporting citations. These webpages will be updated

as federal departments and agencies complete their review of House, Senate, and

enacted FY 2010 appropriations. Each total includes a "Date Published" that

reflects the date that amounts, counts, and supporting citation information was last

modified.

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Earmarks table: FY2010 Earmarks by Appropriations Subcommittee

Appropriations Bill

Earmark        2008 Enacted

2009 Enacted   

FY 2010 House Committee

FY 2010 House Floor

FY 2010 Senate Committee

FY 2010 Senate Floor

FY 2010 Conference

Agriculture and Rural Development

 

 

Count

Amount ($K)

Date Published

525

337,204

04-Sep-2009

494

312,830

09-Mar-2010

323

224,228

11-Apr-2010

323

224,228

11-Apr-2010

302

229,240

11-Apr-2010

302

229,240

11-Apr-2010

465

359,859

11-Apr-2010

Commerce, Justice, Science, and Related Agencies

 

 

Count

Amount ($K)

Date Published

1,738

932,531

04-Sep-2009

1,556

785,690

09-Mar-2010

1,090

371,158

11-Apr-2010

1,090

371,158

11-Apr-2010

564

384,810

11-Apr-2010

567

400,925

11-Apr-2010

1,518

745,389

11-Apr-2010

Defense

 

 

Count

Amount ($K)

Date Published

2,087

6,644,746

04-Sep-2009

2,091

5,577,811

11-Apr-2010

1,132

3,078,455

11-Apr-2010

1,132

3,078,455

11-Apr-2010

793

2,953,160

11-Apr-2010

793

2,953,160

11-Apr-2010

1,759

4,592,471

11-Apr-2010

Energy and Water Development

 

 

Count

Amount ($K)

Date Published

1,781

3,686,124

04-Sep-2009

1,839

3,801,893

11-Apr-2010

617

602,808

11-Apr-2010

617

602,808

11-Apr-2010

547

921,016

11-Apr-2010

547

921,016

11-Apr-2010

965

1,185,239

11-Apr-2010

Financial Services and General Government

 

 

Count

Amount ($K)

Date Published

202

409,240

04-Sep-2009

265

143,204

11-Apr-2010

189

152,800

11-Apr-2010

190

153,175

11-Apr-2010

111

257,631

11-Apr-2010

 

 

278

350,766

11-Apr-2010

Homeland Security

 

 

Count

Amount ($K)

Date Published

122

348,218

04-Sep-2009

131

501,328

09-Mar-2010

151

109,723

11-Apr-2010

158

159,723

11-Apr-2010

25

125,725

11-Apr-2010

25

125,725

11-Apr-2010

177

243,695

11-Apr-2010

Interior and Environment

 

 

Count

Amount ($K)

Date Published

568

436,058

04-Sep-2009

565

447,300

09-Mar-2010

275

158,131

11-Apr-2010

275

158,131

11-Apr-2010

299

236,136

11-Apr-2010

310

242,461

11-Apr-2010

555

371,356

11-Apr-2010

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Budgeting: Allocation and Public Policy 15

Appropriations Bill

Earmark        2008 Enacted

2009 Enacted   

FY 2010 House Committee

FY 2010 House Floor

FY 2010 Senate Committee

FY 2010 Senate Floor

FY 2010 Conference

Labor, Health and Human Services, and Education

 

 

Count

Amount ($K)

Date Published

2,252

899,278

04-Sep-2009

2,163

882,671

09-Mar-2010

1,139

439,574

11-Apr-2010

1,139

441,574

11-Apr-2010

780

453,262

11-Apr-2010

 

 

1,786

823,347

11-Apr-2010

Military Construction and Veterans Affairs

 

 

Count

Amount ($K)

Date Published

190

1,177,245

04-Sep-2009

178

1,329,609

11-Apr-2010

109

578,994

11-Apr-2010

109

578,994

11-Apr-2010

96

628,055

11-Apr-2010

96

628,055

11-Apr-2010

184

1,206,086

11-Apr-2010

State and Foreign Operations

 

 

Count

Amount ($K)

Date Published

5

23,012

04-Sep-2009

1

5,000

09-Mar-2010

0

0

11-Apr-2010

0

0

11-Apr-2010

0

0

11-Apr-2010

0

0

11-Apr-2010

0

0

11-Apr-2010

Transportation and Housing and Urban Development

 

 

Count

Amount ($K)

Date Published

2,053

1,748,036

04-Sep-2009

1,841

1,495,744

09-Mar-2010

1,021

595,775

11-Apr-2010

1,021

595,775

11-Apr-2010

575

733,082

11-Apr-2010

575

733,082

11-Apr-2010

1,505

1,218,913

11-Apr-2010

TotalCount

Amount ($K)

11,523

16,641,692

11,124

15,283,080

6,046

6,311,646

6,054

6,364,021

4,092

6,922,117 

9,192

11,097,121

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e. The Rebirth of Program Budgeting - The ideas of program budgeting continue

to appear in thinking about the budget process, and especially in thinking about

reforms. The basic idea of making the most efficient allocation of money among

competing resources is an extremely alluring one, and politicians and analysts will

attempt to pursue that rationalistic goal even in the face of massive evidence that

it may not be attainable in the rough world of politics.

The Government Performance and Results Act of 1993 (GPRA) represented

the rebirth of the fundamental idea of making the allocation of funds more

rational. The principal concept underlying this legislation was to shift the focus in

assessing organizations in the budget process away from inputs and toward

outcomes and “results.” Thus, each organization in the federal government has

been required to develop a strategic plan and a set of operational indicators of

attaining the goals specified in that plan. The degree of success or failure in

attaining the goals then plays a significant role in determining the budgetary

success of the organization. This process involves neither the direct linkage to

expenditures nor the level of analysis inherent in program budgeting, but it does

depend on some of the same assumptions.

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Analysis

The analysis of this case study addresses a scenario where a recently graduated MPA,

Master of Public Affairs-Administration, is hired by a Congresswoman as the Campaign

Manager, Advisor and Expert on the Federal Policy Process, to advice and recommend policy

updates, status and formulation according to the votes, needs and requests of the candidate’s

constituents. The campaign manager, must stay current on all policy formulation processes and

must make recommendations to the Congresswoman based on the current election and the

budget cycle. He or she must stay current on all policies affecting the programs in the

candidate’s district to make sure that the allocation of funding goes to these programs.

New or younger candidates are less politically networked and might not be current on

policy formulation at the U. S. Capital. This is a clear example of how a candidate might not

know all processes of the budget cycle, along with the endless amount of negotiating with the

agencies that entails the process before the Federal Budget is approved. By hiring a campaign

manager with expertise on policy formulation, the Congresswoman can focus on getting new

votes and keeping the existing supporters happy by addressing their wants and needs and by

focusing on getting approval and funding for much needed programs in her district.

1. Resources/Money – The candidate must have the support of his or her constituents and

should remain transparent on how and where funding is going to programs in the district.

2. Working with and around the Deficit and the National Debt – The candidate must

work closely with the campaign manager, to research the Deficit and the Federal Budget

Process and how funds are allocated for specific programs by agencies and how it may

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affect his or her district. The candidate must be able to adjust his or her agenda based on

constituent popular vote and recommendations.

3. The Top-Five Elements of the Budgeting Process, according to The Heritage

Foundation (www.heritage.org). There are actually ten elements that are crucial to the

Federal Budget Process, however, I will address the top five as these a critical during a

candidate’s campaign during the election process, which the candidate must remain

transparent in order to gain the support and trust of the constituents and be seen as a

candidate with morals, values, and ethics, thus earning the credibility and respect of the

people with a deep-rooted concern for being the voice of his or hers constituents.

a. Element #1: Statutory Spending Caps Taxpayers' bill of rights cap: The most

promising budget reform would be to cap federal spending increases at the

inflation rate plus population growth (economic growth rates could be another,

albeit more loose, target). Lawmakers could allocate federal spending however

they wish as long as total government growth does not exceed this predetermined

rate. Such a cap could save $3 trillion over the next decade by forcing lawmakers

to set priorities and to make trade-offs.

i. Omnicap. Like a taxpayers' bill of rights cap, an "omnicap" would apply a

single cap to all federal spending (including mandatory). Rather than cap

spending increases by a preset formula, lawmakers would manually set

omnicap levels every few years, similar to the discretionary spending caps

of the 1990s.

ii. Discretionary spending caps. Discretionary spending caps successfully

restrained discretionary spending while in effect from 1990 through 2002.

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Bringing back these caps would help to rein in federal spending, although

lawmakers should improve on previous caps with supermajority

enforcement and by closing the "emergency" loophole.

iii. Entitlement spending caps. With entitlement spending projected to

consume the entire federal budget eventually, the country cannot afford to

allow entitlements to remain on autopilot. Lawmakers could write one cap

for total entitlement spending or write a formula that would apply to each

program individually (such as inflation plus beneficiary population). This

could be enforced by requiring Congress to reform excessive entitlement

spending or face an across-the-board sequestration.

b. Element #2: Realistic and Honest Budget Scoring:

i. Accounting for unfunded liabilities in the budget. While businesses

compute their long-term liabilities, Congress does not. Budgets should

include a calculation of all future explicit and implicit taxpayer liabilities

and lawmakers should create a point of order against increasing these

liabilities.

ii. Dynamic scoring of taxes. Currently, Congress evaluates tax policies by

"static scoring," a method that assumes changes to tax policy have almost

no economic impact. History, economics, and common sense prove this

assumption false. Dynamic scoring would more accurately estimate the

economic and budgetary impact of tax changes.

iii. Ending baseline budgeting. Baseline budgeting keeps entitlement spending

on autopilot and creates the false impression that anything less than a

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Budgeting: Allocation and Public Policy 20

large, previously assumed spending increase is a "cut." That is a recipe for

rapidly accelerating spending.

c. Element #3: Strengthening the Budget Resolution:

i. Joint budget resolutions signed by the President. Because concurrent

budget resolutions do not carry the force of law, appropriators can easily

bypass them. A joint budget resolution would not only add the force of

law, but also allow the White House and Congress to negotiate spending

levels in the spring, rather than waiting until the completed appropriations

bills reach the President's desk in the fall.

ii. Dividing budget resolution by committee, not function. The budget

resolution's functional breakdowns have no binding effect and can be

altered by the Appropriations Committees. Dividing the budget

resolution's discretionary spending by appropriations subcommittee makes

more sense, especially since Congress uses this breakdown when filling in

the discretionary budget.

d. Element #4: Enforcing Existing Budget Rules:

i. Requiring a roll call vote to waive a point of order. The House Rules

Committee has routinely reported rules automatically waiving all points of

order against excessive spending. Rules that can be so easily circumvented

quickly become irrelevant.

ii. Requiring a supermajority to waive a point of order. Budget rules are

supposed to prevent a simple majority from violating predetermined

budget standards. Yet allowing the same simple majority in the House to

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Budgeting: Allocation and Public Policy 21

vote to ignore its own rules effectively eliminates all enforcement. Raising

the bar to three-fifths would make it harder to violate budget rules.

iii. Requiring a caucus majority to waive a point of order. If the majority party

fears a three-fifths requirement would give the minority party a veto on

bypassing budget rules, they could enact an internal party rule requiring a

majority vote of the caucus before bringing to the floor a motion to waive

a point of order.

iv. Budget Committee enforcement of spending limits. The Budget

Committees should be empowered to enforce the budget resolutions that

they write. Spending bills that exceed the 302(a) or 302(b) allocations

should be sent back to the Budget Committees for approval, modification,

or rejection.

e. Element #5: Tools for Accountability:

i. Requiring a roll call vote for authorizations. Lawmakers often pass

expensive authorization bills by voice vote, thus removing individual

lawmaker accountability with voters. Roll call votes should be required to

pass legislation authorizing $50 million or more over five years.

ii. Congressional Budget Office cost estimate for every bill. The CBO does

not provide cost estimates for all bills and only rarely for conference

reports. Lawmakers should always know the cost of a bill before they

vote.

iii. Repealing the Gephardt rule. House lawmakers should not be able to hide

debt limit increases by automatically including them in the budget

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Budgeting: Allocation and Public Policy 22

resolution. Lawmakers who truly believe in policies to increase federal

debt should be willing to publicly vote that way.

iv. Term limits for appropriators. Long-time appropriators have some of the

highest spending records in Congress. Even appropriators who may wish

to restrain spending are often required to vote for runaway spending to

remain on the committee long enough to build seniority. Placing a term

limit on membership on these committees would help to tear down the

barrier between appropriators and other Members of Congress, and free

appropriators to vote for less spending.

v. Caucus election of appropriations subcommittee chairmen. Currently, only

the chairman of the House Appropriations Committee is elected by his

peers. Yet chairmen of appropriations subcommittees also have enormous

power and have been accused of wielding that power in ways detrimental

to Congress as a whole. Basic accountability requires that subcommittee

chairmen also be elected by their peers in a caucus vote.

vi. Biennial budgeting. Lawmakers rarely finish all budget bills by October 1,

when the federal fiscal year begins. Biennial budgeting would free

lawmakers to spend more time overseeing federal programs and reforming

failed or unnecessary programs.

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Budgeting: Allocation and Public Policy 23

Concluding Recommendations – Performance Measurement

My concluding recommendations for this case study are for the use of Performance

Measurement in the Federal Budget Process. The Performance Measurement Process is when an

organization uses performance measures and standards to achieve desired results. It is a forward-

looking, continuous process. Performance management can be implemented at the program,

organization, community, and state levels.

What Is Performance Measurement? It is the regular collection of data to assess whether the

correct processes are being performed and desired results are being achieved. First, by using

quantitative measures that provide information about critical aspects of activities, including their

effect on patients. Measures of what “actually happened” can be compared to goals set by your

organization. Second, it analyzes the success of a work group, program, or organization's efforts

by comparing data on what actually happened to what was planned or intended. Finally, it asks

“Is progress being made toward desired goals? Are appropriate activities being undertaken to

promote achieving those goals? Are there problem areas that need attention? Successful efforts

that can serve as a model for others?” It focuses more on the organization when evaluating the

progress and less on the individual provider.

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Why Measure Performance? There are many reasons why an organization or an agency should

measure performance. First, it promotes total Quality Improvement. Measuring performance

can tell you what you’re doing well so you can share your successes and also reveal areas where

you need to make adjustments. Measuring performance tells you whether you are achieving

your ultimate goal of improving patient outcomes. Second, it promotes Transparency to the

public, thus gaining the trust and respect of the community. Third, it encourages Accreditation.

For example, such organizations as NCQA, the Joint Commission, and the Accreditation

Association for Ambulatory Health Care (AAAHC), evaluate health care provider organizations

to provide accreditation or certification signifying that those places meet certain performance

standards. Fourth, it allows for Recognition from the community as providing information that is

credible and empirical. Finally, it promotes Participation or Citizen Engagement. It gets the

community involved and the people feel as if their voice, their opinions do matter.

Concluding Statement: The use of Performance Measurement during the Federal Budget

Process established Performance standards or organizational standards, goals, and targets. It

establishes Performance measures or the development, application, and use of performance

measures to assess achievement of standards. It Reports on the Progress by documentation and

reporting on the progress in meeting standards. Finally, it promotes organizational Quality

improvement or the Establishment of a program or process to achieve quality improvement

based on performance standards, measurements, and reports.

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References

Office of Management and Budget - Earmarks. (n.d.). Retrieved August 9, 2015, from https://earmarks.omb.gov/earmarks-public/

H.R.7130 - Congressional Budget and Impoundment Control Act of 197493rd Congress (1973-1974). (1974, June 21). Retrieved August 8, 2015, from https://www.congress.gov/bill/93rd-congress/house-bill/7130

Peters, B. (Brainard) Guy (2012-10-16). American Public Policy: Promise and Performance (Page 153). SAGE Publications. Kindle Edition.

Riedl, B. (2006, June 15). 10 Elements of Comprehensive Budget Process Reform. Retrieved August 10, 2015, from http://www.heritage.org/research/reports/2006/06/10-elements-of-comprehensive-budget-process-reform

The U. S. Department of Health and Human Services - Performance Management & Measurement. (n.d.). Retrieved August 11, 2015, from http://www.hrsa.gov/quality/toolbox/methodology/performancemanagement/index.html

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