This website uses cookies to ensure you have the best experience. Learn more

Reimbursement And Pay For Performance In Healthcare Essay

1964 words - 8 pages

Pay-for-performance (P4P) is the compensation representation that compensates healthcare contributors for accomplishing pre-authorized objectives for the delivery of quality health care assistance by economic incentives. P4P is increasingly put into practice in the healthcare structure to support quality enhancements in healthcare systems. Thus, pay-for-performance can be seen as a means of attaching financial incentives to the main objectives of clinical care. However, reimbursement is a managed care payment by a third party to a beneficiary, hospital or other health care providers for services rendered to an insured or beneficiary. This paper discusses how reimbursement can be affected by the pay-for-performance approach and how system cost reductions impact the quality and efficiency of healthcare. In addition, it also addresses how pay-for-performance affects different healthcare providers and their customers. Finally, there will also be a discussion on the effects pay-for-performance will have on the future of healthcare.

Discussion
How Reimbursement Is Affected By Pay-For-Performance Approach
Healthcare payers agree with the idea of Evidence-Based Medicine (EBM) to advocate for pay-for-performance in provider reimbursement on quality and efficiency. The fundamental system that most payers use to compensate physicians and provider associations embodies enticements for excellence and efficiency. Reimbursement can be affected by the P4P approach and other factors such as the claims process, out-of-network payments, legislation, audits and denials. While the same P4P approaches are attempts to commence incentives and new strategies into the healthcare, the underlying arrangement of the compensation system produces many personal incentives. As a result, most medical doctors are rewarded on fee-for-service, which is a criterion that has a high percentage of different services with no regard to the assessment and quality of the assistance to a precise patient. Moreover, since most duties are reimbursed more kindly compared to others, the disbursement system also affects the preference of treatment and care along with most therapeutic alternatives and favors the most procedure-based care. Pay-for-performance approach under salary or capitation arrangements and doctors pay are not attached to some services delivered (Langenbrunner, Cashin, & Dougherty, 2009). So, there may be no straight economic incentive to offer services that further increases the concerns about undersupply of needed services. This approach changes the economic incentives which later distresses physicians deliberately or unconsciously.

Capitation and fee-for-service (FFS) are some of the commonly used canonical systems for reimbursement. FSS compensates the extra provision of services; hence, it tends to perform well on access but poorly on cost efficiency. However, capitation compensates preserved services and tends to do well on cost competence but weakly on access....

Find Another Essay On Reimbursement and Pay-for-Performance in Healthcare

Performance-Based Pay for Public School Teachers

1897 words - 8 pages What are good teachers worth, and what is the best way to compensate them? Will paying teachers based on student performance increase the performance of teachers? As student test scores continue to fall, teachers are increasingly being held accountable for the performance of their students. This concern has resulted in a mounting interest and the implementation of a performance-based pay system for public school teachers. Many believe if

Cost Containment and Productivity: Staffing and Scheduling, Pay for Performance, and

1924 words - 8 pages -managed clinics and urgent cares and are benefiting greatly. (HCFO, 2009) This is not only in regards to pay for performance with uninsured or insured patients using these services because of the discounted rates, but it is also show to greatly improve patient outcomes in relation to location, convince, and continuity of care. Cost containment and productivity are both a big part of these nurse managed clinics. From improving patient outcomes to

HRM Performance Related Pay in Public Sector

3255 words - 13 pages following articles:•Evaluating performance-related pay for managers in the National Health Service, by Dowling and Richardson (1997)•Performing for pay? The effects of 'Merit Pay' of motivation in a public service, by Marsden and Richardson (1994)NATIONAL HEALTH SERVICEDowling and Richardson (1997), investigated the applicability of PRP in the managers of NHS - an organization pertaining to the public sector - by examining its effects and

Incentive Pay, Employee Performance and Employee Productivity

3052 words - 12 pages motivate employees to perform at higher levels. (www.uslegal.com, 2001-2014). Employers are practicing the incentive pay systems to promote employees particular behavior and performance to get more involved in the organizational development and which is essential for the organization’s success. So employers use incentive pay program as an effective tool for employees to achieve their goals and improve employees work performance. The purpose

HRM and the Performance related pay

1398 words - 6 pages Before I get started with the arguments related to for and against individualized performance related pay I would outline the reason why such arise at all in any industry and why at first place managers have decided that such a method should be applied in order work to be performed more efficiently.Everything starts with the assumption that pay does not have to "chaotic" in means that every worker should be paid this what he deserves in matter

Inequality Reward Policy and Unequal Pay For Locals in Vietnam

927 words - 4 pages standard of living for the expat as same as when they lived in their home country. Therefore, in some cases, the local staffs who have more complex position still receive a lower reward than the expat. This inequality reward policy has created a conflict among the staff and affected to their performance. In addition, unequal pay schemes can create more dissatisfaction than satisfaction if the local staff perceived to be unfair, inadequate or badly

Undocumented Immigrants in the US and Healthcare for them

1874 words - 8 pages . However, the cost of providing healthcare impacts federal, state, and local governments differently. The United States has a history in which success is associated with greater negativity toward certain groups. Anti-immigration sentiment and extreme immigration policy may come from the desire to blame outsiders for poor economic conditions. Immigrant and minority attitudes as well as policy regulations are tied to economic competition. Current

Pay For Play In The NCAA

2856 words - 11 pages scholarship would be plenty for a college student athlete, but even with that scholarship, many NCAA athletes must make a decision on whether to pay for food or the rent. This stress piles on top of the everyday stresses of schoolwork and heavily impacts the student-athletes and the first part of their name, the student part, which should come first. With their scholarship on the line, students are forced to place their performance in their sport ahead of

Not-for-Profit Healthcare, For-profit Healthcare and Physician Incentives

1543 words - 6 pages physician. An issue with for-profit healthcare organizations is that they serve fewer non paying/unprofitable patients which increase the burden on not-for-profits. For-profit organizations are more concerned with providing attractive looking facilities in areas where there are paying patients. With fewer and fewer not-for-profit facilities available lower income patients are finding it more difficult to find quality healthcare facilities. We will

Performance of the Nursing Department in a Healthcare Institute

1111 words - 5 pages Introduction In any healthcare institute arrangements related to patient hygiene, medication management and other associated problems such as risk of falls are some common problems that need to be addressed and streamlined in an effective manner. The performance of the nursing department of any healthcare institute can easily be assessed through these components and whether they are being followed in a proper manner or not. For this the

Drawing on both expectancy and equity theory, identify and discuss the main factors that are likely to influence the effectiveness of performance-related pay schemes in organisations

1165 words - 5 pages conditions called: expectancy, instrumentality and valence are present. For example, employee X works hard to improve his performance, however the objectives set before him by management perceived by worker as unrealistic. No matter how much effort he puts in there will be no improvement in performance from manager's point of view. The condition of expectancy will not be meet. Therefor, performance-related pay will not be motivated to improve his

Similar Essays

Pay For Performance Essay

754 words - 4 pages as a whole. Another type of pay-for-performance plan that I, myself am more aware of is in the healthcare industry. Due to new accountability standards (i.e. Meaningful Use Measures and Accountable Care), hospitals and private physicians will be paid by insurance companies according to certain criteria that they meet. According to Bloomberg BNA Resources; Nokia, a telecommunications corporation, has recently implemented the pay for performance

Measuring Merit: Pay For Performance Essay

1079 words - 4 pages to states and school districts to help them implement merit pay systems. According to President Obama, “Good teachers will be rewarded with more money for improved student achievement” (Smarick, 2011) Problem Statement The purpose of this hypothetical study is to ascertain the potency of paying teachers for performance in order to promote the achievement of upper elementary students. Districts, challenged by a widening achievement gap, may

Managed Care: Pay For Performance Essay

832 words - 4 pages , physicians, and patients would be better off if health plans aligned their P4P efforts to maximize physician engagement. Works Cited DeBrantes, F., & D'Andera, G. (2009). Physicians Respond to Pay-for-Performance Incentives: Larger Incentives Yield Greater Participation. The American Journal of Manged Care, 305-310. Hahn, J. (2006). Pay-for-Performance in Heath care. Washington D.C. : Congressional Research Service, The Library of Congress. James

Performance Based Compensation Pay For Performance

2532 words - 10 pages skills, knowledge, competency, performance and productivity, all which can be delivered through different invitations, from changes to base pay to introducing gainsharing. HOW DOES PAY FOR PERFORMANCE WORK? If part or all of the one’s salary is contingent on how well you actually perform your job, one will go the extra mile. The individual will attack his/her work with vigor and revel in the rewards. And if the employee and enough of his/her