What Are the Pros and Cons of Paying Physicians by Fee-for-Service

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

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

Once the patient comes through the door payment for services should be top of mind. All copayments and deductibles collected and any other non-covered expenses billable to the patient. The correct information is gathered and if all is handled initially properly within in the cycle the claim can go the workflow and payment received with minimum effort by human hands.

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)

New physicians would be able to focus more on the quality of their practice as opposed to productivity due to being paid on a salary-basis in a large organization that is better-equipped to train incoming physicians. Staff Model HMOs provide care in extensive health systems; therefore, there are abundant resources available to physicians, both physical resources and the resource of additional physicians’ minds and expertise.

The patient is informed about their coverage and the amount of copayment they would have to pay.

The greater income consequence for physicians, in comparison, suggested that contracting with many health plans improved their bargaining power. The results showed that physicians with multiple contracts were more likely to report not having adequate time to devote with patients. This was proportional to physicians with more contracts also had a little more time spent outside patient

You are expected to pay your copayments and deductibles at the time of service. All payments are required at the time of service unless other arrangements have been made in advance.

However, in the event that I need emergency and urgent care services, outpatient or inpatient services, prescription drug coverage, preventative care services or to have imaging done, I am covered at no charge after the $500 deductible. Overall, anything could happen in the course of a year that costs more than $500 dollars and if it does happen, any other services after will be covered, as the out of pocket limit is $500.

The Stanford Health Services and UCSF medical center merger was projected to have a great turnout as it was supposed to be “enhanc[ing] the academic mission[s], strengthen[ing] referrals, and creat[ing] a more cost effective teaching hospital” (Sjoberg, 1999). The two competitors joined forces in hopes that it would alleviate the pressures of the new managed care systems by merging resources and acquiring more bargaining power. Stanford Medicine and UCSF came together at a time when many other academic health centers were looking to improve their negotiating powers with healthcare plans and physician groups. The merger offered hope to UCSF and Stanford by strengthening training programs and offering innovation plans as well as financial support.

Managed care was established in order to manage health care cost, utilization, and quality (Kongstvedt, 2015). In managed care, health insurance is provided through HMO, PPO, and other types of managed care. It has the potential to reduced health care spending and improved the quality of care. However, despite of its success in improving the quality of care through preventive health care services, chronic disease management program, and so forth, many physicians are reluctant to be part of the managed care environment. Some of the reasons are the impact of managed care to physician’s income and autonomy. Under managed care, insurers have decreased the fees paid to physicians. There are different ways how managed care organizations control costs. One of this is through selective contracting with health care providers and hospitals to lower costs. In selective contracting, health care providers agreed to accept lower prices in exchanged for guaranteed volume of patients under managed care plan (Culyer, 2014). This paper will discuss more issues and trends in Managed Care Organizations such as the rise of Medicaid Managed Care spending, the new Medicaid Managed care Rule, and the collaboration of Managed Care Organizations and Accountable Care Organizations to reduce health care spending and improve efficiency of care.

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.

Reimbursement is costs or repayment for health care benefits. In the United States health benefits are often provided before the payment is made. End result physicians, clinics, hospitals, and other health care contributor establishment request reimbursement for health services provided in addition to expenses incurred. Presently reimbursement of claims for healthcare service depends on the appointment of medical codes to explain the diagnosis.

Why or why not capitation can create the greatest incentive for providers to control the cost of delivering health services?

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