The Developing Trends of Healthcare Delivery in the US

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.)

In 2012, the ACA found an excessive amount of readmissions of patients that were hospitalized within 30 days for the same medical conditions. This factor viewed under the ACA as a quality issue and CMS implemented value-based incentive payments based on performance in a set of quality measures. The plan is to implement a pay for performance (P4P) in formulas used by Medicare to reimbursement providers. “The objective is to link reimbursement to quality and efficiency as an incentive to improve the quality of health care, as well as reduce system-wide costs” (Shi and Singh, 2015). In addition to the P4P, nonprofit hospitals also focus on continual improvement, data and cost containment throughout the organization (Adamopoulos,

A mixed payment system combined with physician monitoring, will provide physicians with incentives to consider costs and benefits of different treatment options, which will lead to an efficient level and quality of care. (1,2)

The care delivery enterprise must be re-tooled so that it functions in a fee-for-value reimbursement environment as is has in a fee-for-service reimbursement environment. The Centers for Medicare and Medicaid Services (CMS) is leading the

Obtaining reimbursement for services provided is a necessity for the survival of many health care organizations. This paper will explain, in my opinion, why the Centers for Medicare and Medicaid Services (CMS) are involved in this development and how it affects the American public. I will offer a suggestion to ensure meeting policy and procedure. I will finish by discussing three ideas listed on the CMS website.

They will now receive payments from the quality of care they provide to their patients. Those with higher based value will receive higher payments than their counterparts (Berenson 2010). I think this is very important because the healthcare system has been volume driven for so long that quality healthcare has been an issue for quite some time. In addition to value, this would definitely improve quality and efficiency needed for better patient outcomes.

The American human services framework is experiencing a rapid shift that incorporated a movement from fee-for-service payment into value-based payment that rely profoundly upon the provider integration plus care coordination (Santo, 2014). Value- based installment attempt to realign the economic incentive regarding care delivery by integrating doctors pay to value and quality. The FCA and AKS, are regulatory structures that were basically created to handle fraud and abuse claims emerging from the fee- for-service reimbursement framework.

One major trend in the healthcare environment is the shift from volume based reimbursement towards value based reimbursement. Many provider practices remain on a volume based or fee for service reimbursement plan. This system tends to reward high quantity of services with less regard for the quality or performance of the service. However, with a renewed focus on value, reimbursement plans

Healthcare reimbursement systems within the United States are a complex structure for obtaining payment for services rendered. The healthcare system officers are required to understand the ordinary principles of the payer system. Understanding the rules, and keeping up with the continuous changes will allow the providers, physicians, and facilities to gain an advantage in this growing healthcare domain. Both private and commercial insurance companies provide a diverse menu of choices to customers. All third-party payers create interest in decreasing healthcare costs and improve control access to the not needed services. This paper will address the complexity of the healthcare reimbursement systems in the United States. Additionally, the research

Trends indicate the administrative complexity in the U.S. health care system requires that American hospitals employ far larger staffs to handle billing requirements (Anderson & Squires, p. 1-2). Furthermore, despite enormous innovation and investments in technology, the U.S. is failing to achieve improvements in life expectancy. The return on investment has been low; therefore, examination into other methods to increase quality of care, and decrease costs has become compelling. The U.S. has known for quite some time that health care costs, and therefore spending have gotten out of control. There have been several Presidents who have unsuccessfully attempted to help alleviate the nation of this issue. However, with the implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, we have begun to notice a positive trend, in the said decline in spending. There have been methods implemented to begin helping providers and organizations monitor their progress, reward them for proper adherence, and now there are

The new social contract between the health care system and employers, patients, and the government has given everyone involved some breathing room. They have provided a clearer picture of the costs of health care; however, it is evident that there is still work to be done regarding the transparency of complete and exact costs. For example; all hospitals have a price list called the chargemaster that includes nearly 20,000 health care procedures. The prices on this list are the prices that patients will most likely see on their bills; however, the terms are not standardized and many are bundled services that make it difficult to compare them with other institutions. It is obvious

Americans spend over $8,000 per capita on expenses associated with healthcare while other countries spend an estimated $3,000 and achieve better health outcomes (Fries, et al., 1993). Bodenheimer, Chen, and Bennett’s (2009) article “Confronting the Growing Burden of Chronic Disease: Can the U.S. Health Care Workforce Do the Job?” reports that nearly 75% of U.S. healthcare dollars are spent on the treatment of chronic diseases which include heart disease and diabetes rather than on disease prevention (Bodenheimer, Chen, & Bennett, 2009). In addition, Bodenheimer and Pham (2010) describe how U.S. healthcare involves a fee-for-service payment design in which the hospital and physician receive a payment each time a procedure is performed (Bodenheimer & Pham, 2010). Bodenheimer and Pham explain that physicians are ensnared in

The United States healthcare delivery system is a uniquely developed system that involves various features, components, and services. The US delivery system is massive, with total employment in various healthcare settings of qualified medical professionals that provide key functions to delivering quality healthcare. This essay will discuss the characteristics if the United States healthcare delivery system and how it could be developed from a free market perspective.

Under payment, an ideal healthcare system will have the challenge of delivering higher quality for lower costs. The system’s payment reform will involve a transition from fee-for-service to global from systems that are value-based important for the achievement of the overall healthcare goals. An ideal healthcare payment system will give a great deal of support to value-driven system of healthcare delivery (Kent, 2013). The fee-for-service payment system will be of great importance to the healthcare system as it will help control the costs of health care.

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.