Reimbursement and Pay-for-Performance Essay Example for Free

Reimbursement and requital-for-Performance EssayIntroductionAs we come into the 21st Century, we find wellness c be is at a crisis level. Every agency is working on health fretfulness reform from policymakers to the public and hush-hush sector, as well as feder eachy funded Medi flush and Medicaid. The business of Medicine is greatly influenced by the government (federal official, democracy and local levels) and private health sections that initiate policies. Pay for Performance is a reimbursement method where physicians and hospitals can vex a higher reimbursement for duplicate run ground on the fact that they deliver better fiber c ar with better results and resultant designs. This payment reform offers initiates intended to improve faculty, pry, and character of health c atomic number 18 (Hood, 2007). If all adulterates receive the same dollar amount as a doctor with poor outcomes, then the doctor with great outcomes should receive a little more and there go o ut be patients that do not mind paying a higher deductible for better medical checkup services (Mayes, 2006).Definition for Pay for executingKimmel (2005), Pay for mathematical operation is a payment approach use in health precaution that is based on clinical information-driven reform. The fundamental concept is to tie payment to how well providers adhere to employment standards. The practice standards are evidence-based and tied to clinical outcomes. The primary areas of focus are preventive care livery and disorder management for chronic illnesses.Effects on ReimbursementPay for military operation (P4P) is literally a group of performance indicators that are coupled with an incentive. The performance indicators supports the performance aspect of P4P plot the incentive indicator is the pay compvirtuosont. measuring rod patient outcomes and understanding the variances thatthey have, has in firearm work to the increasing rise in how pay for performance reimbursement is lo oked at. This style of reimbursement allows health plans and employers to pay increasing reimbursements to medical providers that have the better outcomes, give average outcome medical providers a chance to improve, and pay those medical providers with the lowest outcomes the least amount of money or not pay them at all (Cromwell, Trisolini, Pope, Mitchell, Greenwald. 2011). In order to have a pay for performance system in place, you must decide what domains or areas you wish to track, measure, and reward.Some areas in this domain are clinical process, tint and patient safety, access to and availability of care, cost efficiency or cost of care, cost-effectiveness, administrative efficiency and compliance, adoption of information technology, and reporting of performance indicators. These can be set up as a single performance tracker or a multi-domain performance tracker and the measure needed for returns, importance, and cost. Performance indicators should be valid, reliable, and informative (Cromwell, Trisolini, Pope, Mitchell, Greenwald. 2011). The Incentive Schemes reward the performance measures, and is another important part of a pay for performance system. Funding proves to be another important part of this type of a reimbursement system. Types of funding take on redistributing breathing payments where additional funds testament not have to be made and the tincture of service is already high however, medical providers with a lower smell of service will receive lower reimbursements. Generated nest egg and New Money are other sources of funding for performance measures. Generated savings claim that an increased quality of service will generate savings, although there are others who feel that new money should be used to fund the performance system. (Cromwell, Trisolini, Pope, Mitchell, Greenwald. 2011).Impact of System Cost Reductions on the Quality and Efficiency of wellness parcel out The Medicare Physicians Group Practice (PGP) was the first physician pay for performance model used by the federal government. The PGP believes that higher quality and better cost efficiency could be achieved by managing and coordinating patient care and by engaging in wider choices of care management that are able to improve cost efficiency and quality of health care. Interventions include chronic sickness management, high risk and higher cost care management, transitional care management, end-of-life and palliative care programs. If there were a moresuccessful payment and delivery method to increase the value of health care and improve quality of care, the cost would grow at a slower pace. The American people would be more likely to purchase health indemnification coverage that is affordable and more valuable. (Kautter, Pope, Trisolini, 2007).More progress toward effective delivery and system reform is one of the key elements to achieving the goals to push expanded coverage. Information technology is one of these key elements and a maj or part of pay for performance system. Information systems uses electronic medical records and patient registries have been created to improve the efficiency and quality of health care delivery. These type of initiatives that are being tested to see if cost savings are generated by reducing avoidable hospital stays, cutting down on re portals and emergency room visits, while simultaneously improving quality of care (Kautter, Pope, Trisolini, 2007). Effect of Pay for performance on health vexation Providers and Their Customers Meredith B. Rosenthal states, Pay for performance will not replace the existing payment structure in both system, but it does allow payors to take into account a set of quality indicators, in addition to record of service (as fee-for-service does now) or the number of covered lives (in the case of capitation). In this view, pay for performance can be viewed as a mechanism to correct some of the distortionary incentives that already exist in the reimburseme nt system.Physicians in the fall in States are paid on a fee-for-service basis. This encourages high volumes of services, where there is no regard to the value of services in regards to a patient. When services are reimbursed more generously than others it allows the payment system to influence additional medical services with a heavy emphasis on procedure-based care. Since the physicians pay is not attached to medical services provided, there is really no direct incentive to provide any services (How exit Paying for Performance Affect Patient Care?. (2006, March). Virtual Mentor, 8(3), 162-165).Effects of Pay for performance on the approaching of Health CareGoldberg lists three points regarding the most significant implications of the movement toward paying for quality outcomes. These are that the quality and value become real parts of contractual reimbursement, the differences based on quality outcomes will be more evident grouped with provider tiers,and quality metrics evolve to outcome-based and chronic disease management (Goldberg 2006). P4P is an incentive-based reimbursement system that rewards the best players. This pay for performance system is currently active in health systems, managed care settings, and private and group physicians practices. P4P is likely to impact the entire health care environment and will provide yet another opportunity for pharmacy to become an active role player and leader with improving quality and efficient health care. The focus is not on value but on quality and cost. Pay for performance is not a new program, but in the age of informed choice, evidence based medicine, and patient safety, it can become the solution to our current health care dilemma (Pay for performance (P4P) Evaluating Current and Future Implications).ConclusionThese pay for performance systems and programs will lead expansion across the United States health care industry in the near future. With the implementation of the low-priced Care Act, there ha s been a great amount of provision made to encourage continued improvement with quality of care. Accountable Care Organizations (ACOs) are groups of providers that agree to coordinate care and to be held accountable for the quality and cost of the services they provide (James, 2012). There needs to be a consensus as to how much of an incentive will have to be given in order to affect the needed change and how should these incentives be paid out monthly, quarterly, or yearly and how can these improvements be sustained over time. Continued experimentation with the pay for performance model should begin to incorporate monitoring and evaluation in identifying design elements that will also affect outcomes in a positive way.Variations in health care markets should be evaluated and include comparison groups to isolate pay for performance from other types of factors. Pay for performance has some great attributes to it and could unimpeachably be the beginning to improvements in quality of service. If physicians are receiving patients and referrals based on their ability to provide quality of service with reduced readmissions and more satisfied consumers, then the care they take in providing services to patients from admission to discharge will create positive change.ReferencesCromwell, J., Trisolini, M. G., Pope, G. C., Mitchell, J. B., and Greenwald, L. M., Eds. (2011). Pay for Performance in Health Care Methods and Approaches. RTI oppose publication No. BK-0002-1103. Research Triangle Park, NC RTI Press. Retrieved June 15, 2014, from http//www.rti.org/rtipressGoldberg, L. (2006). Paying for performance a call for quality health care. Deloitte Center for Health Solutions. Retrieved from http//www.deloitte.com/assets/Dcom-UnitedStates/Local%20Assets/Documents/us_chs_p4p_032806%281%29.pdf Hood, R. (2007). Pay-for-Performance-Financial Health Disparities and the Impact on Healthcare Disparities. Journal of the National aesculapian Association, 99, 1-6. James, J. (20 12). Pay-for-Performance. New payment systems reward doctors and hospitals for improving the quality of care, but studies to date show mixed results.. Health Policy Brief, 1-6, Retrieved June 15, 2014, from http//www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=78. Kautter, J., Pope, G., Trisolini, M. (2007, Fall). Medicare physician group practice demonstration design quality and efficiency pay for performance. Health Care Financing Review, 29(1), 15-29. Retrieved June 15, 2014, from http//www.cms.gov/Medicare/Demonstration-Projects/DemoProjectsEvalRpts/downloads/PGP_Demo_Design.pdf Kimmel, K. (2005). Pay for Performance An economic Imperative for Clinical Information Systems. Retrieved June 15, 2014, from http//www.himss.org/content/files/PayForPerformance.pdf Mayes, R. (2006). The Origins of and Economic Momentum Behind Pay for Performance Reimbursement. Health Law Review, 15, 17-22. Pay for performance (P4P) Evaluating Current and Future Implications. Retrieved June 15, 2014, from https//www.ashp.org/DocLibrary/Policy/QII/Pay for performance.aspx Rosenthal, M. (2006). How Will Paying for Performance Affect Patient Care?. Virtual Mentor, 8, 162-165.