Riverpoint Writer Reimbursement and Pay for Performance essay

Often expressed as a payment model programs offering financial rewards to physicians and other related healthcare providers who meet defined performance targets which tend to focus on quality, efficiency, or related, according to ARQ Resources (n. D. ). There are five types of APP programs: (a) individual-based pay programs; (b) sales compensation programs; (c) executive incentive compensation programs; (d) team/group based variable pay programs ; and (e) and company incentive programs (Federal, 2004).

Also known as (APP), equally important this payment model downside is that it penalizes caregivers for poor outcomes, medical errors or increase cost margins. The reimbursement system at the moment generates different stimuli for the providers that are apparent in its existing environment some negative, others positive. In the same fashion, Physician has proven that a large quantity of preventative care is not lucrative for providers in terms of reimbursements, (Orzo, 2005).

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The fee-for-service model does not take into account cost management, quality, and efficiency, whereas the APP primary objective is laity assurance and controlling costs. Not to mention receiving added value from increased medical expenditure is arduous beneath the present types of compensation. Although this may be true, there are four strategies that address the quality of health care that consist of government guidelines, marketplace competition, interminable quality enrichment, and compensation catalyst.

The last approach has been transforming the way providers and insurers optimize the payment procedures to increase efficiency, as well as quality assurance and improve value. According to American Academy of Family Physicians (2004), on the other hand reimbursement affects APP approach in the fact that the physician has an incentive to improve quality care to earn more bonuses, therefore increasing their annual income by 10% profit margin. It is important to realize that quality health care is not a commodity that can easily be measured.

Under those circumstances healthcare is analysis from a national point of view, consumer’s abilities to match up services provided across regions and providers affects the perception of quality. Because we are unable to assure our diverse population over a respective period of time span to determine whether pay-for-performance is cost effective, we can only base its success on research. A researcher (n. D. ), according to Agency for Healthcare Research and Quality, the current system rate reductions has a significant impact on the quality and efficiency of health care.

For this reason, countless analyst is concerned that the Affordable Care Act will diminish the value and effectiveness of healthcare because there will be too many patients but not enough quality healthcare providers. TO put it another way sometimes incentives do change practices; however, clinical results do not get better. In addition, incentive base medical care has the potential to place Physicians at a greater legal risk. They must make sure that enticement centered medical care will not take the powers that be out of the doctors back workplace and transfer them to the authorities in the legal profession.

Point often overlooked, “It is important to ensure that physician will not practice defensive medicine within the auspices of the payment system but rather will act solely as an advocate for the proper medical care of their patients” Christianson, 2006). According to Med-vantage, a California health informatics company, as of February (2006), there were approximately one hundred fifteen APP programs. The result of the employer, health plan, and government initiatives are why the programs emerged. Pay-for-performance affects health care providers and their customers in a positive way because it improves quality, therefore increasing value.

The value is important for the success of any business because it helps define a path that leads to high performance, resulting in top quality assurance. The provider becomes more expansible for his or hers action and accountability because of reward incentives. This motivation affects the customer because now they will have a better experience, better-personalized attention to their health, and incentives to be healthy because of the cost savings in the immediate and future. Pay-for-performance is positive for all stakeholders involved because it delivers on the main objectives to increase quality while reducing costs.

Epstein (2004), believes that “APP may adversely affect the income of physicians practicing in minority communities particularly poor minority immunities?thereby potentially reducing both the number of doctors who work in such communities and their ability to invest in processes to improve quality’. The outlook of medicine appear very diverse than it did in current years. For individuals who entered the medical field to become future physicians to take care of patients, alleviate disease and create a bona fide alteration in the health lifestyles of individuals.

Current responsibilities expend their time and liveliness and make them greater distances from that goal of quality healthcare. Simply a resetting of the status quo, pay-for- reference will take considerable time and effort, ultimately benefit the health care professional and their patients in the long term. According to Rand Corporation (201 0), analyzers results propose that pay-for-performance insurance plan require conformation to account for the imbruement deficit that medical disparities may possibly deteriorate.

A line of attack could be to endow physicians with targeted grants for caring for the susceptible populations, which may well counterbalance resource disproportion while sustaining the motivation to enhance treatment for the particular populations Para. 9). “Rewarding primary care physicians for providing better care to patients could end up widening medical disparities experienced by poorer people and those belonging to racial and ethnic minorities,” (Rand Corporation, 2010).

In conclusion, improving the quality of care at decreased cost apparently will place more demand on healthcare professionals. Defining pay-for-performance, as well as discussed how reimbursement is affected by the pay-for-performance approach has provided an overview of this financial plan future. Further discussion described how system cost reduction impacts latherer, quality and efficiency, how APP affects health care providers and their patients, and the effects pay-for-performance will have on the future of health care.

The recurring theme in the health care environment is that we are doing less with more. Reimbursement and pay-for-performance new approaches aimed at changing the health care delivery system into a more cost efficient system that will be able to meet the needs Of the consumer in a fair and effective way. For the foreseeable future clearly, the practice of medicine, is undergoing a radical, permanent change, better described as the livery of healthcare. The future is speculated to go in either direction of the wheel.

Only time and government policies will be able to shape truly the actual history of what is to come in the decade of the healthcare delivery system. Approaches to progress quality and to lessen the expenditure of healthcare in the U. S. Contain value-based purchasing. An incentive-based reimburse resentment system to drive positive change utilizes Pay-for-performance is a type of value-based purchasing. Regardless of definitive evidence that pay-for-performance (APP) can increase quality in a cost-effective manner, it is apparent that other payers are relocating swiftly toward this paradigm.

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