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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, (Rizzo, 2005). The fee-for-service model does not take into account cost management, quality, and efficiency, whereas the P4P primary objective is quality 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…
Managed care organizations can save money by providing lower prices through contracting large volumes of services and reducing the amount of hospitalizations (Getzen & Allen, 2011). This essay presents a scenario in which I am a representative of Castor Collins Health Plans responsible for maximizing profits and minimizing risks. Within my job description, I am advised to develop a comprehensive health insurance plan for two entities: ConstructIt and E – Editors. This essay explains the company’s employee demographics, health risk factors, premium amount the company is willing to pay, and what company I chose to offer a health insurance plan. Based upon my analysis of potential utilization, I will provide two reasons…
The cost of health care in the United States remains an important concern for American consumers. The challenges for controlling costs and providing a better health care system are various and complex. These challenges, in many cases, are in the realm of the Department of Health and Human Services (HHS) or other federal or state agencies (Department of Justice, 2012). Hospitals continue to team up with other facilities, insurers and for-profit companies, although the cause of the bump in M&A activity varies. While some hospitals cite financial problems, others join forces because of collaboration mandated under the Affordable Care Act and changing reimbursement models, according to Minnesota Public Radio (Caramenico, 2012).…
Over time, the development of several partnerships between hospitals and the physicians that work there is considered an integrated physician model. The types of places this model could be seen are acute care hospitals, nursing homes, employed physicians for primary care and independent medical groups to name a few (Harrison, 2016). The goal behind the integrated physician model is for an agreement between both the hospital and the physician that will benefit the health care system as whole. There is a model that suggests hospitals work under an agreement with physicians that will market a successful network. In this case, physicians are in a shared partnership with the hospital. Another option is physicians working for the hospital, allowing…
In October 2012, the Centers for Medicare and Medicaid Services (CMS) is implementing the Hospital Value-Based Purchasing (VBP) Program. This initiative will reward acute-care hospitals with incentive payments for the quality of care they provide to people with Medicare. This means that DRGs are still in place, but incentives can be reached based on how well the hospital performs on certain quality measures, or how much the hospital’s performance improves compared to its…
When a physician office practice is purchased by a hospital system, the hospital system takes over the fixed costs like office expenses as well as administrative tasks like scheduling. Most important, are upgrades to electronic health records that comply with federal mandates CITATION McK13 \l 1033 (McKinsey, 2013). These are very costly and become a responsibility borne by the purchasing hospital system. It is clearly an attractive option of physicians. However, research indicates that the hospital systems themselves are losing money on the transactionsCITATION Num13 \t \l 1033 (Numerof, 2013). According to Moody’s hospital systems that purchase physician practices see an average increase of 5.2% for salaries. This is a major increase considering the thin margins hospitals operate on (Moody’s 2013). Most hospitals see a net loss on their investment in physician practices (Moody’s 2013). Why then would they do it? The reason lies in control. In exchange for shuffling off the risk of operating a practice to the hospital system, the physician gives up some measure of autonomy. Hospitals can directly contract a physician’s behavior and incentivize his prescribing behavior CITATION Hea13 \l 1033 (Healthcare Economics Editorial Board, 2013). This is unique, as not even payers could so directly influence a physicians practice. This means that the financial interests of the…
However the extra attention to detail of a patients life and health habits may reduce the amount of patients each provider can services, having to focus more time on each patient for higher quality of care makes it very difficult to keep the quantity of patients. Usually the fewer patients a provider has is helpful and allows the provider to provide better quality of care, however there are not enough current providers to service the number of patients in the United States. Providers are left with the struggle of balancing the number of patients they can service with the quality of care they can provide. While the idea of Pay-For-Performance systems is good there are concerns about the future effects on the health care system. One concern is that providers will pick and choose their patients by their health history leaving the sickest without care. The Pay-For-Performance system focuses on the outcomes of patients treatments as well as the manner in which they are treated. Because it is easier to have healthy patients if you start with patients that are not that sick in the first place it is a concern that providers will only take on patients that have simple or no health…
There is a growing need in our current healthcare society for controlling costs and quality of healthcare services. Clearly this need for "middle-ground" options or payment reforms are desired in order to provide greater flexibility and accountability for the costs and quality of care than typical pay-for-performance, shared savings, and medical home programs, but which avoid forcing providers, particularly small physician practices, to take on more financial risk than they can manage or to take accountability for services they cannot effectively control.…
A large misconception associated with this concept is that pricing makes a small difference in overall profitability. Studies have demonstrated that the recovery rate (financial return a hospital expects for every dollar of rate increase) of those who completed strategic pricing had a recovery rate of 15.5% compared to the method of increasing across-the-board (13.5%). The contracts negotiated show magnitude in profitability, however, other factors are a considerable factor, and strategic pricing aids in defensibility when adverse things happen (Cleverley, 2008).…
References: Becker, Epstein & Green, P.C (2011) “HEALTH REFORM: CMS Innovation Center Announces Four Models in Bundled Payments for Care Improvement Initiative,” Retrieved from http://www.ebglaw.com/showclientalert.aspx?Show=14876…
Over the years there has been a pervasive issue in health care because of the Pay-for-Performance (P4P) Programs. Pay-for-performance is defined as a plan of reimbursement that connects compensation to quality and effectiveness as a motivation to develop the health care quality as well as making a decrease in costs. Hospitals and providers are being encouraged by government agencies and individual health plans to encourage excellence standards. Pay-for-performance methods could cause consequences such as reduction admission to care, add differences care, and weaknesses to improve. There could be an impact of the health care quality and efficiency by providers getting financial rewards if they show better care for patients as well as showing quality of performance. P4P could affect the providers and customers by the measured performance, payment policy, and the involvement implementation matters. The P4P effects that will be seen in the future of health care is that the population will see that pay-for-performance will expand, especially the Affordable Care Act.…
The traditional fee-for-service and the usual, customary and reasonable methods by the hospitals and physicians to the diagnostic related groups and resource based relative value scale. The establishment of accountable care organizations and advanced primary care practice and payment methods like bundle and global payments are briefly explained. The Patient Protection and Affordable Care Act (ACA) which was passed in 2010 has also provided with multiple provisions in the development of new methodologies. ACA resulted in the formation of Center for Medicare and Medicaid Innovation (CMMI) under the Center for Medicare and Medicaid Services (CMS) to put forth some innovative models with an idea of tying the Medicare payments with a value based model. The aim is to formulate some potential prospects of reducing the healthcare cost while increasing the efficiency of the system and improving the overall care of the Medicare beneficiaries. The review also provides some alternative methods to the current Medicare system in comparison to other countries around the…
Kleiner, B. H. (2012) Gives insight into conducted research to show how research of managed care has increasingly become a leading development in regards to the finances in managed health care. There have been many debates and, much confusion of the origins and, definition of managed care yet, the goals are to reduce costs, increase profits and, still provide quality services. The events that have led to managed care is due to constant changes within the health care management sectors as, all throughout history as, when the industries change there also is a need for change to meet the demands to finance managed care.…
Healthcare Managers Expect ‘Value-Based’ Contracts To Hurt Profits; Providers Pessimistic: KPMG Survey . (2014, June 19). Retrieved from KPMG: http://www.kpmg.com/us/en/issuesandinsights/articlespublications/press-releases/pages/healthcare-managers-expect-value-based-contracts.aspx…
If I could change the world I would make every country more independent and isolated. Almost all of the countries today depend on others for goods and financial support. For example, the United States depends greatly on China for our goods and other resources. The foreign policy that the United States has isn’t the most efficient that we could get it as a country.…