Reimbursement and Pay-for-Performance in Healthcare Essay

Pay-for-performance (P4P) is the compensation representation that compensates healthcare contributors for accomplishing pre-authorized objectives for the delivery of quality health care assistance by economic incentives. P4P is increasingly put into practice in the healthcare structure to support quality enhancements in healthcare systems. Thus, pay-for-performance can be seen as a means of attaching financial incentives to the main objectives of clinical care. However, reimbursement is a managed care payment by a third party to a beneficiary, hospital or other health care providers for services rendered to an insured or beneficiary. This paper discusses how reimbursement can be affected by the pay-for-performance approach and how system cost reductions impact the quality and efficiency of healthcare. In addition, it also addresses how pay-for-performance affects different healthcare providers and their customers. Finally, there will also be a discussion on the effects pay-for-performance will have on the future of healthcare.Reimbursement and Pay-for-Performance in Healthcare Essay

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There exists a growing trend in the United States called pay-for-performance. Pay-for-performance is a system that is used where providers happen to be compensated by simply payers to get meeting particular pre-established steps for top quality and performance (What is usually Pay-for-Performance, n. a. ). We are going to end up being discussing what pay-for-performance is usually. There are different facets of pay-for-performance which include; the effects of reimbursement by this approach, the effect cost savings has on quality and efficiency of healthcare, the impacts to the companies and sufferers, and the results on the way forward for health care.Reimbursement and Pay-for-Performance in Healthcare Essay

Pay-for-performance (P4P) and value-based purchasing are terms that can be heard within the medical care industry which in turn, describes payment systems that reward medical professionals, hospitals, and other health care providers for their quality and efficiency. The purpose of pay-for-performance (P4P) initiatives is always to link reimbursement to top quality of healthcare as well as decrease systemwide costs (Shi & Singh, 2012). Government agencies and private overall health plans will be in the process of establishing programs hoping to inspire hospitals, doctors, and other services so that they will begin to meet the quality of specifications and attain the ideal outcome for patients.Reimbursement and Pay-for-Performance in Healthcare Essay

The overall goal for pay-for-performance is always to increase the top quality of healthcare, while minimizing the medical costs by implementing programs that will concentrate on things such as precautionary care which would contain services such while annual tests and vaccines.

Measurements and Incentives

With regards to quality of care measurements there are different categories one of which being structure. The structure steps patients usage of health care, the application of electronic devices and the patients experience of the care that they received. Offers can be both financial bonuses or non-financial incentives.Reimbursement and Pay-for-Performance in Healthcare Essay Pay-for-performance has numerous prosbecause it assists increase the determination of the doctor or health care facility which in return will how the business that the person care for their very own job and wants to always be rewarded based on their great behavior and quality of care that they provide the affected person with. There might be a con when it comes to pay-for-performance which can be that if the physician or staff would not have the right knowledge, schooling, and knowledge then they is probably not able to reach or surpass the goals that have been established. When the appropriate knowledge, training, and experience is a problem than this can cause the organization to have to fund into having that individual the training and methods that they need to receive the set goals.Reimbursement and Pay-for-Performance in Healthcare Essay

How Reimbursement can be Affected

When it comes to the pay-for-performance programs they’ve been introduced to the care program to offer bonuses to medical professionals, hospitals, and other medical establishments however the actual structure of the payment system already generates a lot of bonuses on its own. Presently in the United States most of physicians happen to be paid over a fee-for-service basis, which in results encourages a top volume of companies, without consider to the value of the service to the patient. In the health care industry there are solutions that after they are performed the reimbursement is somewhat more generous around the payout than others.Reimbursement and Pay-for-Performance in Healthcare Essay

This paper will define pay-for-performance, reimbursement and how this affects pay-for-performance, how organizational costs reductions impact the quality and efficiency of health care, the affects on health care providers and customers from pay-for-performance and finally the future of health care and the effects of pay-for-performance.

Pay-for-Performance

Pay-for Performance has become a widely used term and will be expanded upon during the implementation of The Affordable Care Act. Pay-for Performance was designed to offer incentives to health care providers to optimize the delivery of health care to their patients.Reimbursement and Pay-for-Performance in Healthcare Essay

This plan was designed and developed with improving delivery of health care by rewarding the providers who reduced unnecessary health care services, improved quality of patient care, and reduced health care costs.

Providers are offered lump-sum payments for certain ailments that require certain follow-up visits, incentives for healthier patient statistics, and rewarded for improved performance over the year before. Pay-for-performance will continue to become a key term in shaping of the health care system in the future because this plan will hold the providers accountable to improving the quality and efficiency of health care and provide more opportunity for other providers to have an impact as well.Reimbursement and Pay-for-Performance in Healthcare Essay

Pay-for-performance has become popular among policy makers and private and public payers, including Medicare and Medicaid. The Affordable Care Act expands the use of pay-for-performance approaches in Medicare in particular and encourages experimentation to identify designs and programs that are most effective (James, 2012). Pay-for-performance plans also contain penalties for providers that fall short on achieving goals or lowering health care costs. The Medicare program no longer pays hospitals to treat patients who acquire certain preventable conditions during their hospital stay, such as pressure sores or urinary tract infections associated with use of catheters (James, 2012).Reimbursement and Pay-for-Performance in Healthcare Essay

Reimbursement affected by Pay-for-Performance

Health care organizations reimbursement will be affected by pay-for-performance through the strategies that are used to improve quality while lowering costs. Effective communication of performance goals to staff, establishing accountability for front-line staff, and working collaboratively with other disciplines and departments will be important steps in successfully meeting pay-for-performance demands (ASHP, n.d.). All these factors affect the evaluation process of obtaining reimbursement along with any bonuses the organization may receive by improvements made throughout the organization.Reimbursement and Pay-for-Performance in Healthcare Essay

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Under the Affordable Care Act health care organizations will be encouraged to use Value Based Purchasing (VBP), which includes pay-for-performance incentives and will be used to provide bonuses for health care organizations that meet and exceed Centers for Medicare and Medicaid Services (CMS) standards and regulations.Hospitals will be rewarded for how well they perform on a set of quality measures as well as on how much they improve in performance relative to a baseline. The better a hospital does on its quality measures, the greater the reward it will receive (Health Affairs, 2012).Reimbursement and Pay-for-Performance in Healthcare Essay

Organization costs reductions impact the quality and efficiency of health care As health care organizations continue to maintain quality and efficient health care the costs associated often rise the supports of pay-for-performance agree with the primary concern is improving quality of patient care and motivating the providers to reach these goals. Maintaining a balance between quality of care and making sure that the level stays adequate as the costs of care go down is the main focus. However, there are providers that believe this plan will lower the costs of reimbursement so far that the quality of care will be impacted. Another issue for providers is the cost of adopting the health information technology needed for data collection and reporting.Reimbursement and Pay-for-Performance in Healthcare Essay

The pay-for-performance can modify the current offers that medical doctors, hospitals, and also other medical companies already obtain. Reimbursement features affected the pay-for-performance within a positive method because physicians are able to fiscally gain by it to get providing their particular patients with quality medical services. Repayments are reinventing the way that health care is going to be delivered mainly because health care providers will be able to amplify their revenue through bettering their top quality of treatment, instead of that being the fee-for-service variety.Reimbursement and Pay-for-Performance in Healthcare Essay

Pros of Pay-for-Performance intended for Patients

Once patients find physicians who have are part of the pay-for-performance software this can be beneficial for them. The key reason why that patients see rewards is because the physician works with the patients individually to get better health care outcomes for the person. If a affected person has heart disease then the doctor will give attention to that concern and will assist the patientto get it back to normal which in come back the doctor will see a motivation for this and the patient wins as well as they are getting the treatment that they want and their overall health is going to increase as a result of the services provided.Reimbursement and Pay-for-Performance in Healthcare Essay

System Cost Cutbacks

The system costs reductions will have a positive effect on the quality and efficiency of health care. A lot of expert have worried that the Cost-effective Care Act will weaken the quality and efficiency in health care simply because there will be much more patients rather than enough top quality health care providers. In respect to Agency for Healthcare Research and Quality (n. d. ): In 2150, health care spending rose to $1. three or more trillion dollars, or typically $4, 637 per person. Being a percentage of the Gross Household Product (GDP), it grew from 13. 1 percent in 1999 to 13. 2 percent in 2000. National well being expenditures are required to reach $2. 8 trillion in 2011, with an average annual growth rate of 7. a few percent from 2001 to 2011. By simply growing installment payments on your 5 percent quicker that then a GPD, costs will ingest approximately seventeen percent of the GDP in 2011(para. 6).Reimbursement and Pay-for-Performance in Healthcare Essay

Affects in providers and Customers

Pay-for-performance affects physicians and their buyers in a great aspect as it improves the caliber of health care that they can receive from their physician which in return boosts value. The pay-for-performance program will take medical care from fundamental health care delivery to top quality health care delivery. The way that this is going to impact the patient “customer is because they will likely have an general better experience with more awareness of their all around health. The patient may also see benefits because there are bonuses for individuals when they live a healthy lifestyle. One of the incentives that the individual will see is at cost savings in the immediate foreseeable future.Reimbursement and Pay-for-Performance in Healthcare Essay

Pay-for-performance is usually positive for all those stakeholders engaged within the plan because it offers on the absolute goal which is to improve the quality of care to patients when reducing the cost. The pay-for-performance will also support health care providers to determine more rapport and generate a good feedback within the community because when their individual receives quality health care providers then the individual is going to go back and inform their friends and family about their confident experience and recommend that physician to their lovedones.Reimbursement and Pay-for-Performance in Healthcare Essay

Effects on Future Health Treatment

Pay-for-performance courses are expected to expand over the United States health care in the near future, particularly with the implementation of the Cost-effective Care Action. The pay-for-performance is going to always increase the top quality of healthcare that the affected person receives from their health care provider. Pay-for-performance is eventually going to be all across the usa and more doctors are going to be taking part within this motivation program which can be going to begin making medical care affordable for most Americans who cannot afford healthcare coverage as well as services. In the foreseeable future we are going to start to see healthier Americans because they are likely to get healthcare services that are tailored solely on their medical needs. Doctors are going to begin working to provide top quality care to get their sufferers healthier whether it be getting all their weight in order, blood pressure, and various other health issues.Reimbursement and Pay-for-Performance in Healthcare Essay

Conclusion

Pay-for-performance and refund is changing the health treatment delivery program into a even more cost efficient health care system that before. This is certainly going to increase the quality of care that one receives as it steers away from fee-for-service and gives physicians motivation to provide their very own patients which has a better quality of car as a result of incentives that they can receive. You will discover going to be many seniors that are going to start requiring even more health care solutions and with this pay-for-performance implementation it is going to give them an improved quality of care than in previous years. With the pay-for-performance incentives this is certainly going to inspire doctors to get their individuals in total better wellness which in the future we will most likely start seeing a decrease in serious illnesses because patients will be working toward a better and healthier lifestyle.Reimbursement and Pay-for-Performance in Healthcare Essay

Pay-for-Performance Jamie D Knutter HCS/531: Health Care Organizations and Delivery Systems October 1st, 2012 Instructor: Doreen Gounaris Pay-for-Performance “Pay for performance has become a central strategy in the drive to improve health care” (Joynt, Jha, Orav, & Epstein, 2012, p. 1606). There are many aspects of pay-for-performance. These aspects include; 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, the effect on the future of health care. Currently an estimate of half of all Medicaid programs  Reimbursement and Pay-for-Performance in Healthcare Essay
This approach makes for a competitive aspect amongst health care providers also (Wiscombe, 2001). Reimbursements are greatly affected by the pay-for-performance approach. “Most P4P approaches adjust payments to hospitals, individual physicians, networks of physicians or medical practice groups” (Mayes & Walradt, 2011, p. 39). Ways that reimbursements are given are; bonuses based on percentage of care delivered, bonus payments per patient with high quality of care, and a percentage of the total cost savings achieved in relation to what cost would have been without high quality of care (Mayes & Walradt, 2011). Tying financial incentives to care provided is an approach improving the quality of care (Joynt, Jha, Orav, & Epstein, 2012).Reimbursement and Pay-for-Performance in Healthcare Essay