Revelations Case Study

Pay-for-performance payment model – healthcare payment systems that offer financial rewards to providers who achieve, improve or excel their performance on specified quality of care and cost measures (HealthCare Incentives Improvement Institute, N.D.)

First implemented in 1985 by Aetna (previously U.S. Healthcare), P4P programs were used to reward top performers and improve outcomes (Bruno, 2012). The incentives were meant to improve the quality of patient care by basing incentives on patient outcomes. Conversely, fee-for-service reimbursements are based on the treatments and set limits on the amount reimbursed for services. Because of these limits, incentives for use of pharmaceuticals and non-invasive procedures can impact how physicians practice.

Four compensation models are laid out by the Bangor Family Physician case study. These models include: (1) revenue model; (2) net income model; (3) base salary plus

In addition, the reward could be made various direct at different individual clinicians. As the rewards are divided into two categories, monetary and non-monetary and in each categories, there contains various contents, such as, perquisites, vacation trips and participation in decisions. Managers should implement incentives to staff according to each individual’s requirement, which make the reward be durable and have greater value to make employees remember

In the early 2000s, serious deficiencies in quality health care had been highlighted by the Institute of Medicine (James, 2012). Recently, the use of financial incentives to reward for improving quality of care is a growing interest for many. Pay-for-performance programs provide bonuses to health care providers for meeting or exceeding quality measures. However, physicians in the United States have traditionally been paid for quantity versus quality of care (Blum, 2011). Utilizing incentive models, such as patient-centered medical home, pay-for-performance, and the fee-for-service payments are the most commonly used programs. Incentive programs may also reward on improvements that occur over time, such as year-to-year decreases in hospital readmission rates or decreasing hemoglobin A1c values in diabetic patients (Blum, 2011). Hospital can incur financial penalties under the Medicare guidelines for individuals who acquire certain preventable conditions during their hospital stay, such as urinary tract infections from use of catheters and pressure ulcers. However, there is insufficient evidence to support whether or not financial incentives improve quality of primary health care. In addition, it is unclear whether financial incentives could potentially cause harm as they only incentivize based on certain health indicators. Therefore, physicians may spend more time focusing on meeting those indicators while paying less attention to other important issues

“Revelation,” written by Jennifer Donnelly, takes place in the center of Paris France in modern time. The suicidal protagonist named Andi Alpers who lives in brooklyn, goes on a trip to france with her dad that is not really there for her. This trip gives her time for her to study and write her senior thesis. So she may graduate on time from high school. While she is in Pairs she finds a Diary from a girl who lived during the French Revolution. The protagonist makes a lot of new friends and some become on of her love interest. Andi uses music and the guitar to escape the real world to have a break. But needing to finish here thesis by the end of they week so she can fly back to Brooklyn be with her mother. Her mother is mentally challenged

As our healthcare system continues to evolve and the concept of pay for performance becomes a reality in many areas, I can’t help but question how the concepts addressed by Grant Halvorson (2011) may be applied to providers of diabetes care and education. In a pay for performance structure, HCPs may either be reimbursed additional funds if outcomes exceed target goals, or funds may be reduced if outcomes are less than target. This represents a significant change from the standard fee for service structure in which most HCPs are accustomed (Leichter, 2006). In order for HCPs to thrive financially in this changing environment, it would appear that HCPs and practice managers would both be well served learning more about goal setting and feedback delivery mechanisms. The way goals are structured and the way feedback is provided, may either help or hinder results (Halvorson, 2011). From my personal experiences observing practices move towards this model, it appears that there is a significant gap in understanding of how to best prepare and continue to motivate HCPs within the pay-for-performance structure. While HCPs seem to understand the bigger picture performance goal, they appear to lack understanding of the specific steps, or mastery goals, they can take to incrementally improve their patient’s outcomes. The question of how to best prepare and set HCPs up for success in this new system remains largely unanswered. However, it would appear that more effective goal setting would be

In 1998, the Massachusetts General Orthopedic Associates (MGOA), a specialized unit within Massachusetts General Hospital (MGH), hired Dr. Harry Rubash and Dr. James Herndon, respectively, to help to remedy the annual financial deficits, which were “financed” by dipping into endowment and borrowings from MGH. These financial deficits have been continually getting into MGOA’s mission of providing high-quality patient care, research, and teaching (Barro 3). In the immediate months after accepting their positions of leadership, both Rubash and Herndon steered the hospital into the green turning a modest profit. However, it was clear that their new initiatives wouldn’t be viable for the long term. To do so, Rubash and Herndon proposed a new physician compensation plan. This plan included a development fund tax, a bonus, in addition to periodic adjustments to a base salary based on individual physician performance in regards to how profitable the physician was for MGOA. Initial physicians’ reaction to the proposed plan varied, however, if the case study was an indication, Rubash and Herndon were determined to implement their plan.

According to Harris (2015), Apocalyptic works essentially reveal something that was previously hidden, such as the future or the unseen spirit world. Apocalyptic authors, including the author of Revelations, often reveal a vision in which they meet supernatural beings, such as angels or monsters, who speak of God’s future intentions. The Book of Revelation is filled with symbolism used to paint a picture of events that show the battle between good and evil. For example, Jesus is described as the lamb of God. A lamb that is small and harmless, yet dies to save the world from sin. The dragon, who symbolizes satan, causes readers to react fearfully. The lamb defeats the dragon, or the light triumphs over the dark, and the dragon is sent back into

For many generations critics of the book of Revelation have tried to discredit it because it contains certain events that were seen as completely impossible to ever be literally fulfilled

P4P rewards physicians, hospitals, medical groups, and other healthcare providers when they are able to meet certain performance measures of quality (indicators for quality) and efficiency. In contrast, it may penalize caregivers for suboptimal outcomes, medical errors, or increased costs.

The question of how do financial incentives influence physician’s behavior has long been discussed among health economists. The purpose of financial incentives can be summarized as to control the use of health care resources so that cost could be controlled, to increase physician productivity, and to improve quality of care. For example, in this table, the major concern of the five articles is that, whether financial incentives have a significantly positive relationship with physician productivity and the quality of health care provided. In principle, the use of financial incentives is intended to give physicians motivations to provide higher quality in their practices, however, in reality, the outcome could be contradictory, as there are

Pay for performance (P4P) system improves the quality of care by creating a patient-friendly, respectful, more humane and excellent patient care atmosphere( Stanowski, Simpson & White, 2015). I believe that patients should be treated with courtesy, respect and there should be a consumer involvement in a patient care plan. Today’s healthcare system is focused on patient’s satisfaction and health care outcome so I agree that reimbursement in the future is proofed to be based on the customer satisfaction. “Since 2012, hospitals have been rewarded and penalized based on the customer satisfaction”(Stanowski, Simpson & White, 2015), which is an excellent way to provide an optimal level of patient satisfaction. According to the research, there is a positive relationship between the pay for performance and patient satisfaction (Stanowski, Simpson & White, 2015).

Jesus Christ is the Alpha and the Omega. He is the first and the last, and He is in complete control of everything in between. God verifies this truth in Revelation 1:8 by saying, “I am Alpha and Omega, the beginning and the ending, saith the Lord, which is, and which was, and which is to come, the Almighty.” He also proclaimed Himself as the Alpha and Omega in Revelation 21:6 and 22:13.

The book of Revelation conveys both some of the most joyous and challenging times for the world. The book is ultimately about the glory of God being revealed and the events that take place in the end times. The author of this book is the disciple John, who was given this vision and revelation while he was a prisoner on an island. The time of writing was around 90 A.D. and the purpose is the give encouragement and hope to all people who believe in and follow Jesus, as well as telling them to stand strong and wait for the return and victory of Jesus; that is the most joyous section. The other side of this book warns of the final judgment to all who have not accepted Jesus and the events they must endure on the last day; this is the challenging