The Dominant Payment Model

The policy issue that I have selected to discuss herein is the pay-for-performance payment model. I feel that this impacts a large number of our population and changes in this regard should be made. This type of payment model aims to use reimbursement to incentivize providers to deliver high quality services. Pay-for-performance model steps away from the traditional manner of reimbursement of fee-for-service, in which providers receive payment on the basis of frequency or volume of the services they provide regardless of outcomes. In contrast,

Consequently, it become a financial problem where physician sees no improvement in their revenue/profit, and the cost of treatments continue to rise as reimbursement challenges the physician’s charges. There is always a cost to a better health care and coverage, and vast of it comes from taxation. Hospital and physicians function on funding to keep the door open and operating, and majority of the funding are from taxation. For

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

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)

Another factor that has contributed to the over-utilization and increased treatment charges is the fact that providers set the prices for services. Patients were free to seek any type of healthcare services that they thought they required for their well-being, while providers set the costs for each service that was billed to indemnity insurance companies (Shi & Singh, 2015). Insurance companies had little control on the types of services that the patient received and prices billed for each service. The fee-for-service model encourages excessive and unwarranted procedures and offers no incentives to utilize economical services

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.

Another issue for fee-for-service system is that the providers set the prices for services. Patients were free to seek any type of healthcare services that they thought they required, while providers set the costs for each service that was billed to indemnity insurance companies (Shi & Singh, 2015). Insurance companies had little control on the types of services that the patient received and prices billed for each service. The fee-for-service model encourages excessive and unwarranted procedures and offers no incentives to utilize economical services (Smith, 2010). While the patients enjoy the freedom of being able to seek out their own services, over-utilization of expensive services on unnecessary and highly technical services increased healthcare costs.

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

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.

One of the thing that stick out to me in my educational journey was the number of steps involved to calculate payment for Inpatient Prospective Payment System (IPPS) or Hospital Outpatient Prospective Payment System (OPPS). Both payment systems use Wage Index Adjustment and provision for high-cost outlier or new technology to provide additional payment for patients with high cost for care. Dr. Ruggieri explains in his book the business pressures doctors and surgeons were exposed to from doctor recommending surgeons affiliated with the same hospital. I was more surprised with the treatment surgeons face being pressure to recommend an operation for patients even if their medical opinion indicate it isn’t medically necessary. It seems like years of medical school and residency doesn’t exempt these medical professionals from being treated like a hard low-wage

Any proposed policy to improve healthcare must address the current payment method, and the rising cost of healthcare. The common reimbursement method for healthcare services is the fee-for-service payment model. It requires providers to figure-out all incurred costs to render services for patients. Additionally, providers need to determine what is the insurer proposing to pay, which thought to reward quantity over quality. An alternative to this model is using a bundle

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 move to use electronic cash in an ironically termed society dubbed “cashless”; there are many issues that include

Online payment processing services perform transactions at a much greater speed than manual processing. As well as ensuring error-free computations and faster processing time. Which means