A Report On The Healthcare Industry

The change to value based purchasing has bought many challenges to the healthcare industry. With the change to value-based purchasing for payments, it has changed how healthcare organization receive payment and delivery care. The advantage of have value based purchasing is that it improves the quality of care while reducing cost in an effort of aligning patient’s with the right provider and treatment plan (Minemyer, Jun 29, 2016). However, there are many disadvantages, such as it increases the patient volume as counteracting the reduction of procedure volume (Brown, B. & Crapo, 2016). Also it makes providers more responsible for care that is beyond the expected treatment of care needed (Minemyer, Jun 29, 2016). With quality measures tied

The payment system in the healthcare industry has appealed to specialty care providers, they make a higher income than the primary care physician. The physicians are attracted to specialty care, and the individual feels that specialty care is better. If physicians were all paid well, in order to pay for their education and then continued quality training, we would not be confronting the lack of primary care doctors who are available to treat the general needs of the population (Fisher, 2013). Just as the physicians seem to be treated differently in our health system so are the patients. Using a multi-tiered system of health care where some insurance gives out a higher payment to physicians, some patients seem to be wanted while others are less well received, this leads to an “everyone for himself or herself ethic” within our medical system (JAMA, September).” The design of the system is flawed in reference to the primary care physician and with the patient who has insurance which pays less, the way to reorient both is to make the pay scale more competitive for both. The primary care physician should be able to make money and cover this educational expenses and the patient should have insurance that will equate to

The health facility in this case study experienced several problems and issues beyond possible solution efforts by the time. One of the main problems is based on the perfect way of handling the various challenges attributed to a shift from the hospital’s fee-for-service in the case of managing care environment. Besides, some local physicians were loyal to Dr. William and had the necessary flexibility and availability to assist the doctor in various ways, but today they are no longer available to assist the doctor towards the achievement of his medical and societal mission. The physicians were always available and loyal to the doctor and they could volunteer their efforts especially in cases of physician shortages in the health center. The physicians cannot afford the time they once used for volunteering activities in the health facility to assist Dr. Williams (Swayne, 2008). The reason behind this problem is that the physicians have now been employed by various managed health care organizations. Others have been involved in various contractual agreements such that the partners prohibit them from working with the health care facility. Although the health care facility has a few small groups or individuals offering primary care, these individuals and small groups are still struggling to survive in the industry. As such, the majority of them cannot

It is commonly believed that the method of physician remunerations affects their professional behavior. As a result, payment systems are therefore manipulated in attempts to achieve policy objectives with the primary aim to improve quality of care, contain cost and maintain recruitment of human resources in underserved areas. (2,1)

This is a big advantage for health care administrators in the Unites States, by getting choice of some of the best and brightest health care professionals of the future. This alone gives them an advantage to attract patients from all locations to receive top quality health procedures. World renowned physicians give great publicity to organizations which usually translate into a large amount of donations towards medical science and technology. This leads to increased ability to recruit top medical professionals and be on the forefront of innovation. Third party payers benefit from inflation of costs, because increased demand on services from the top physicians. This allows them to create prestige tiers for insurance costs because of the quality of the service

Hospitals should be encouraged to participate because improving hospital care is likely to be essential to success (McClellan et al, 2010). Accountable care organizations can be implemented through different payment models. These could include opportunities to share in demonstrated savings within a fee-for-service environment, in which providers took on no new financial risk. They could also include limited or substantial capitation arrangements, in which payments were unrelated to the volume of services provided, to the intensity of service use, or to the frequency of face-to-face meetings, and in which providers took on some financial risk for poor-quality results or failure to control costs (McClellan et al,

There had been previous research that displayed that managed care contracting added to physician dissatisfaction and also their administrative expense. It was determined that physicians had the option to choose to contract and also the number of contracts to have. The results of this survey suggested that physicians who contract with more health plans worked more hours and earned more money.

In the United States, health care has become a huge expense and has threatened the economy; additional measures need to be taken to address the rising cost of care. An individual spends an estimated eight thousand dollars a year in health care expenditures. Therefore, we need to recognize that how a physician reimbursement for payment has a vast impact on the economy and the rising cost of health care.

Health maintenance organization’s (HMOs) use of the primary care physician (PCP) as the “gatekeeper” initially had MCOs view restrictions as a negative approach to patients’ choices. However, some necessary steps have started to be implemented which reduce unnecessary utilization by enforcing some restrictions.

However, this concept is very hard to enforce because it is hard to determine what makes a treatment the best for a patient. Is it the least painful or the cheapest or the most “intense”? What experience does the doctor have to draw from when choosing a treatment option? Each patient and doctor is so unique that it is hard to create just one umbrella method of treatment for an ailment which creates a degree of variability in physician practices. What complicates the matter even more is the fact that physicians are able act in ways that only serve themselves (Aaron, 2008). This means that a value-based payment system would need to include a reimbursement level for physicians who act selfishly. However the only way to determine a physician’s motivation would be to ask, and no physician is to willing admit to being selfish especially if they know that this admission will decrease their reimbursement. When it comes to physician practice variation, a good model to think of is the Wennberg variation which ultimately shows that there is no explanation for variability in physician practice (Aaron,

This articles presents very informational data regarding physician compensation and the promotion of health and well-being. The underlying premise of this article is that the interest of physicians and patients as well as the community should be better aligned to improve clinical and population health outcomes. The author presents The Triangle of Patient Centered Compensation as the ideal model to design or redesign compensation programs that seek to achieve better alignment between physicians, patient, as well as the community. She returns to the question stated in the title of the article, “Are Physician Paid To Promote Health and Well Being? The author concluded that it is hopefully evident that physician compensation makes a difference

The text outlines many issues related to physician engagement both financial and pragmatic. Through out the decision making process physicians are consulted to make clinical decisions and ultimately those decisions and outcomes are measured and discussed with sometimes non clinical staff. In addressing the pragmatic and financial barriers from engagement the ACA has brought to the table value based payment model in paying physicians for outcome based criteria. Do you think these payment models will be effective in bringing physicians to the table alongside physician executives to aide in engagement toward specific groups that would report to that physician executive?

Under capitation, physicians are given incentive to consider the cost of treatment. Pure capitation pays a set fee per patient, regardless of their degree of infirmity, and gives physicians an incentive to avoid the most costly patients (Miller, 2009). Providers who work under such plans focus on preventive health care, as there is greater financial reward in prevention of illness than in treatment of the ill. Such plans avert providers from the use of expensive treatment options. The proponents of this method of payment especially insurance companies argue that when health care providers are not paid extra for additional office visits any associated medical expenses, they are likely to be more conservative with their treatment assessments

The positive outcomes that have resulted due to value base programs have caused the model to gain traction and ignite one of the largest changes in history in the health care marketplace. By linking reimbursements to service quality, insurers such as the Centers for Medicare and Medicaid Services have facilitated a massive leap forward in the performance of United States health care providers. This achievement is a considerable accomplishment in the face of an institution that has received reimbursement from insurers via a fee-for-service model during the last 75 years. Soon, valued based payment models will represent the norm as more insurers support initiatives such as shared savings program, integrated clinical care, and accountable care payment models.

Hospitals and health systems in the U.S. are experiencing a remarkable transformation in their business models directed from numerous influences that are projected to ultimately turn the industry around. Pressures include providers troubled with the quantity of services they are responsible for, to providers who concentrate on presenting high-cost services that give emphasis to sustaining healthy populations (Dunn & Becker, 2013).