The Anti Competitive Agreement Within Private Healthcare Industry

UMC should not only implement an activity based cost system, but strengthen its influence by creating goals for both the residents and doctors. These goals would be designed to encourage both parties to improve the total quality of their information system and promote the efficient use of resources while maintaining satisfaction rates of patients. The incentives such as promotions, awards and vacation days should be offered to anyone who achieves

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.)

Retrospective reimbursement method was based on actual cost the providers assumed the previous year. On this method rates were evaluated retrospectively and costs were used to determined the amount paid to the provider and had no incentive to control cost. On the other hand, prospective reimbursement methods can determine in advance how much a provider is going to get compensated. (Shi & Sing, 2017) The way retrospective reimbursement contain perverse financial incentives happened when institutions increased their profits by increasing costs and this system payment method was based on costs. Due to this issue the method was changed to the prospective to avoid abuse of the system.

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.

Over the years there has been a pervasive issue in health care because of the Pay-for-Performance (P4P) Programs. Pay-for-performance is defined as a plan of reimbursement that connects compensation to quality and effectiveness as a motivation to develop the health care quality as well as making a decrease in costs. Hospitals and providers are being encouraged by government agencies and individual health plans to encourage excellence standards. Pay-for-performance methods could cause consequences such as reduction admission to care, add differences care, and weaknesses to improve. There could be an impact of the health care quality and efficiency by providers getting financial rewards if they show better care for patients as well as

Financial Incentives for Primary care: Comparison costs of practices using PCMH model to those that do not and achieved savings (by reducing hospital admissions and unnecessary tests, they can get half $ back. The catch is that they only get the $ if they’ve met a whole checklist of quality measures for preventive care, chronic disease management and so on. Primary Care is rewarded for efficiency without sacrificing quality. Half of savings goes to Geisinger’s own health plan that funds extra services and creates medical homes. The health plan earned 2.5 times its R.O.I. back in the first year.

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)

There is a growing trend in the United States called pay-for-performance. Pay-for-performance is a system that is used where providers are compensated by payers for meeting certain pre-established measures for quality and efficiency (What is Pay-for-Performance, n.a.). We are going to be discussing what pay-for-performance is. There are different aspects of pay-for-performance which include; the effects of reimbursement by this approach, the impact cost reductions has on quality and efficiency of health care, the affects to the providers and patients, and the effects on the future of health care.

The predominant system of payment to healthcare service providers had been the fee-for-service system for years. This system rewarded the providers for the intensity of their work. However, greater volume of services was not necessarily associated with better service quality. This incentive structure had policy makers concerned and thus, came the pay-for-performance into being established to improve service quality. The use of this system has been expanded by the Patient Protection and Affordable Care Act (PPACA). Many studies were performed to identify ways to make the system more effective. However, the studies had somewhat mixed results.

As you know the reason that for CMS and other health care agencies to come up with quality incentive payments (QIP) to enforce compliance and improve quality patient care because of the rising medical costs, staggering patient safety concerns, rampant malpractice. The increasing burden of chronic disease, health insurance fraud and inappropriate pay become a heavy burden that the health care unable to bear financially and it was the impetus for incentive payments. However, some argue that incentive payments are dangerous pernicious because providers may avoid accepting patients with complicated problems and who are simply incompliant of care. Bonis, (2005) stated, ” A potentially even more pernicious outcome of QIPS would occur if providers,

In addition, United Health Group developed Primary Care Physician (PCP) Incentive Program to motivate physicians to provide high-quality, cost effective care. This program provides physicians’ practice with the opportunity to earn a bonus payment by meeting a core subset of UnitedHealthcare 's traditional quality and cost-efficiency criteria. Another incentive program is Patient-Centered Medical Home (PCMH) Program. The PCMH program provides enhanced payments for primary care providers that implement the medical home model of care.

of the physicians can be defined. MGOA can then start to assign cost requirements to each physician

A principal-agent relationship arises whenever the principal contracts the agent to perform services or supply goods. As set out in the contract, the agent needs to put efforts to produce the output required by the principal, for which the principal pays the agent rewards contingent on particular circumstances occurring. The physician-patient relationship is always modelled within the theory of agency, with consideration of the associated incentive problems. In particular, a physician's is characterized by multiple tasks and multiple principals. Therefore, some dimensions might be difficult to measure and monitor within a classical agency theory. For example, after the physician putting his effort in the first period, it is difficult to measure the amount of effort he will put in the future. Although it might be able to determine whether or not a operation is successful right after the surgery ends and therefore to measure how much effort the physician puts, it is difficult to predict the quality of post-operative care. In this case, the informal payment contributes to ensure physician's follow-up effort.

Thanks for your informative post, I agree, pay for performance is a reimbursement method aimed at improving the experiences of patients at various health institutions. This method as you mentioned is becoming popular among health care policymakers and health care insurers. it is a method based on incentive paid by health care insurers to providers to encourage the overall improvement of providers’ healthcare services to their patients . The pay for performance is considering a method of reimbursement that has shifted much of the financial risks to the providers of health care. The shift in risks to providers could be a double-edged sword. For one, the method can be credited for allowing physicians accountability for costs containment and wellbeing of their patients to be emphasized within the health arena. On the other hand, P4P could result in physicians enrolling patients with less complicated health problems in the practices, or it could lead to physicians avoiding healthcare facilities in poorer neighborhoods with many chronic ill patients. That said, researchers do not concur that the pay for

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