Thursday, October 24, 2019
Reimbursement and Pay for Service Essay
Introduction In this paper we will discuss what pay for performance is and explain what the reimbursement affect is. In this paper it will show how the system figures out cost reduction and the impact of the quality care patients receive. How does reimbursement and pay for performance affect the physicians? Does this affect us now and will it in the future? Health care has been changing dramatically because of history, political and social along with economical reasons. Reimbursement and pay for performance can and may even change the quality of care. Pay-for-performance because our current payment system we are using is not emphasizing preventive care for patients or consumers. Pay-for-Performance is payment used in the health care it is and has been based off of clinical information. The idea is to help tie the payment to what and how well providers help the cost of health care drop. The intent is for preventive care medicine to helping decrease and help with the management of chronic illness. (Pay-for-Performance Incentive Programs in Health Care ( N.D.) With in several months studies have shown that the studies show that the pay for performance works and others that say it does not work. Effect of Pay-for-Performa nce on Reimbursement Here are some examples of pay for performance is Bridges of Excellent, which is a nonprofit health care plan. Its major factor is patients with diabetes. They feel like over 60% of patients with diabetes donÃ¢â¬â¢t get the proper treatment and care. The American Diabetes Association has standards and the Bridges to excellent plan gives annual bonuses to physicians in specific areas such as Boston, Louisville and Cincinnati these cities could and have meet the requirements of this health care plan. On this plan Diabetic care calls for the patient being compliant with care and medications. In this plan the blood sugar test and kidney function and retinal exams would haveÃ to be done on a consistent bases. In this plan compensation is up to and over $100.00 per patient for the providers that stick to the rules. Another plan is Anthem Indianapolis this plan started in 1999 that employed over 25 OBGYN providers in Ohio. This is the oldest plan within the US. This plan is done on and by patient satisfaction. Providers push generic drugs instead of name brand ones. Pay For Performance Pay for performance is a movement in health care field. Providers under this arrangement are rewarded for meeting pre-established target dates for specific health care services or procedures. This is also known as Ã¢â¬Å"P4PÃ¢â¬ or Ã¢â¬Å"value-based purchasing,Ã¢â¬ this rewards physicians, clinics, and rehabilitation centers, Surgical clinics, hospitals, medical groups, and other healthcare providers. They are rewarded for meeting certain performance measures, as well as quality and efficiency. (Wachter, Bob; (2012) Pay for performance does things such as eliminating payments for negative consequences of care. Which can be medical errors from all health care providers. Errors have increased costs. With increase of seasoned senior citizens and disability patients the high rising cost of health care has brought the P4P to the front of the line. Brought P4P to the forefront of health policy discussions. There have been some studies done by several large healthcare systems. With this it has shown improvements with specific outcomes. A little efficiency has taken effect, but at no cost savings. How much are they really saving because the cost of administrative services is still required. Explains how reimbursement is affected by the pay-for- performance approach. Within the last decade or years the economy has had many people becoming unemployed and finding jobs at a lower pay rate as to where they cannot afford insurance because they are to high. With being done more people are applying for Medicaid and with all the seasoned senior citizens retiring and receiving Medicare these two insurances are already participating in this service. Majority of health care systems are participating. Many believeÃ that for- profit and non-for-profit health care facilities believe in lower cost for providers that meet the standards of quality care. Care field. There is a perception that cost is driving up health care treatment. Cost reductions lowers cost of visits, emergence room visits, and urgent care visits. It also helps providers to promote preventive care to their patients. Making sure that all hospitals and providers are on the same scale of service. Preventive care helps prevent insurance premiums from rising at cost to the company and consumer. Effect of Pay-for-Performance health care Providers and their Patients This plan has the support of providers, hospitals and even patients. With this pay for providers must have and use good judgment for treatment and medication and test that maybe ran. The health care cannot be rated by race, ethnic background, or the patientÃ¢â¬â¢s social status. This plan should not judge by a patientÃ¢â¬â¢s location. This plan is and should be a relationship between patient and provider. The provider needs to understand the patients beliefs and it may help them to treat them and respond to certain myths and recommendations that the provider may suggest. Hospitala and providers and helat care workers are being encouraged to buy into the P4P by different agencies and tahe government. Individual health plans area chiming in also. It has pros and cons such as weakness that may or may not improve health care. It is suppose to help lower or slow down ER visits and physicians visits. Now if the providers give quality and efficent care they would and could get financial rewards if patient care improves. P4P measures performance and policy set up for putting this service in action. Discusses the effects pay-for-performance will have on the future of health care The P4P effects that will be seen in the future of health care is that the health care field will see it expand. Pay-for-Performance-defined a reimbursement service that will have links to payments for quality care, which will be an incentive to help improve health care quality of patients by physicians, and hospitals. In improving health care it is suppose to reduce the cost of It was expected that hospitals and providers would respond to P4P incentives. For future health care will based on quality health care and it will become a contract for reimbursement. Patients should feel like they have gotten theÃ value of their money. One effect of future health care is those physicians and hospitals that donÃ¢â¬â¢t participate will be at less to receive patients. Patients that have this health care plan will be more apt to seek physicians that participate. (Goldberg, L; (2006) Conclusion People in the health care field are getting interested in the pay for performance because the health care guidelines and regulations are changing in Medicaid, Medicare and private insurance. More hospitals and clinics and specialty facilities and rehab centers are loving receiving incentives for their participation and in the process they are saving cost to patients and insurance companies. P4P is working with insurance companies and providers for the quality of care for patients to be improved. Now managed care is now looking at pay for performance. Reimbursement being linked to pay for performance is like being paid to shop for the best bargain or the most person to fit your needs.