Pay For Performance
Reimbursement and Pay-for-Performance
Candace Mills
HCS/531
June 16, 2014
Mrs. Baptist
Introduction
As we come into the 21st Century, we find Healthcare is at a crisis level. Every agency is working on healthcare reform from policymakers to the public and private sector, as well as federally funded Medicare and Medicaid. The business of Medicine is greatly influenced by the government (federal, state and local levels) and private health sections that initiate policies. Pay for Performance is a reimbursement method where physicians and hospitals can receive a higher reimbursement for duplicate services based on the fact that they deliver better quality care with better results and outcomes. This payment reform …show more content…
The fundamental concept is to tie payment to how well providers adhere to practice standards. The practice standards are evidence-based and tied to clinical outcomes. The primary areas of focus are preventive care delivery and disease management for chronic illnesses”.
Effects on Reimbursement
Pay for performance (P4P) is literally a group of performance indicators that are coupled with an incentive. The performance indicators supports the performance aspect of P4P while the incentive indicator is the pay component. Measuring patient outcomes and understanding the variances that they have, has in part lead to the increasing rise in how pay for performance reimbursement is looked 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. …show more content…
(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 Medical Association, 99, 1-6.
James, J. (2012). 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
Candace Mills
HCS/531
June 16, 2014
Mrs. Baptist
Introduction
As we come into the 21st Century, we find Healthcare is at a crisis level. Every agency is working on healthcare reform from policymakers to the public and private sector, as well as federally funded Medicare and Medicaid. The business of Medicine is greatly influenced by the government (federal, state and local levels) and private health sections that initiate policies. Pay for Performance is a reimbursement method where physicians and hospitals can receive a higher reimbursement for duplicate services based on the fact that they deliver better quality care with better results and outcomes. This payment reform …show more content…
The fundamental concept is to tie payment to how well providers adhere to practice standards. The practice standards are evidence-based and tied to clinical outcomes. The primary areas of focus are preventive care delivery and disease management for chronic illnesses”.
Effects on Reimbursement
Pay for performance (P4P) is literally a group of performance indicators that are coupled with an incentive. The performance indicators supports the performance aspect of P4P while the incentive indicator is the pay component. Measuring patient outcomes and understanding the variances that they have, has in part lead to the increasing rise in how pay for performance reimbursement is looked 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. …show more content…
(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 Medical Association, 99, 1-6.
James, J. (2012). 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