Reimbursement And Pay-For-Performance Analysis

1358 Words6 Pages
Reimbursement and Pay-for-Performance The cost of healthcare in the United States is continually increasing. Over the past decade, the financial situation in the United States, emphasized by the cost of health care, has cost many employees in the health care field to accept lower wages or face unemployment. The healthcare premiums required for health care benefits have created strain for employers and employees. Increasing enrollment in government programs, such as Medicaid and Medicare, has created tension on the governmental budgets. The Patient Protections and Affordable Care Act of 2010 intend to address the current inadequacy of the incentive structures in the United States health care system. A reimbursement model in consideration…show more content…
Because there have been a multitude of different models of pay-for-performance, prominent examples can show how these strategies will affect the provider’s reimbursement. The Accountable Care Organization (ACO) is one of the best known programs under the pay-for-performance model. Providers in the ACO “agree to coordinate care are to be held accountable for the quality and costs of the services they provide” (James, 2012, pg. 3). The value-based purchasing rewards hospitals for their performance based on quality measures, which means that the hospital will be rewarded as it positively deviates from the baseline. Physician quality reporting is another way for providers to seek reimbursement as incentive for providing quality information to Centers for Medicare and Medicaid Services…show more content…
The programs tend to be geared toward patients with “high-cost conditions – including chronic conditions (such as diabetes, asthma, coronary artery disease, or congestive heart failure) and acute conditions (such as heart attack and hip and knee replacements)” (Mathematica, 2009, pg. 3). While applying emphasis on wellness and drives for positive outcomes, using technologies such as electronic medical records and computerized and systematic methods, will help provide improvement toward patient health outcomes. The goal for providers under pay-for-performance methodologies is to use “financial incentives to encourage improvements in the quality of care by rewarding providers that perform well on measures representing recommended services and practice modifications (e.g., implementing electronic medical records)” (Mathematica, 2013, pg. 3). Using the previously discussed methods, providers are encouraged to provide a higher level of care to the patients and a higher integrity of practice in order to gain optimal
Open Document