...Reimbursement and Pay-for- Performance Edward G. Walker HCS531 May 26, 2014 Tracey Lane Reimbursement and Pay-for- Performance This paper will define Pay-for- Performance; I will explain how reimbursement is affected by Pay-for- Performance approach. I will discuss how system cost reductions impact the quality and efficiency of healthcare. I will discuss how Pay-for- Performance, effects healthcare providers and their customers. I will discuss the effects of Pay-for- Performance and the effect it will have on the future of healthcare. First we must understand what reimbursement and pay performance is. Pay-for-performance is referred to as an umbrella term with performance initiatives that are designed to improve efficiency, quality of the health care system. Pay-for-performance is a reimbursement plan that links payment to quality and effectiveness as an initiative to improve the quality of healthcare and reduce costs. Reimbursement is what the insurance company will pay to the provider and the reimbursement may be only a partial amount of what the actual charges. (Health Affairs, 2012) How is reimbursement affected by the pay for performance approach? This reimbursement method is a where some providers and hospitals pay better than other healthcare facilities for the same service. Their patients appear to have better health outcome results. The two main objectives are; (1) To increase the overall quality of health care that a patient receives. (2) To encourage...
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...Pay-for-Performance University of Phoenix HSC/ 531 * Paper includes the following: Defines pay-for-performance. Explains how reimbursement is affected by the pay-for- performance approach. Discusses how system cost reductions impact the quality and efficiency of health care. Discusses how pay-for-performance affects health care providers and their customers. Discusses the effects pay-for-performance will have on the future of health care Pay-for-Performance is 1,400 to 1,750 words in length Even though the effects of pay-for-performance will influence the future of health care in patient care, reimbursement to the healthcare providers will require close monitoring. The physician receives reimbursement for providing quality care and for making quality innovations. Pay-for-performance offers financial incentives to close the gap in healthcare the patients receive and the healthcare the patients could receive. The effect of pay-for-performance for the healthcare providers depends on his or her quality and efficiency of services he or she provides to the patient. The consumer groups, government, and patients are actively applying pressure on healthcare organizations to lower the costs, improve patient safety and care, and to enhance services (Shi & Singh, 2012). Definition To define the pay-for-performance in the healthcare payment system is rewarding the providers who achieve, improve, and exceed his or her performance on quality and lower the cost. ...
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...International HRM ‘Wolfgang’s Balancing Act’ Case Study Task 1 Cultural contingencies that shape employee behavior in Healthcare As the world becomes more interdependent, the business and the process of doing business are exposed to many, continuously changing dimensions, structures and opposing forces. In a global environment, culture is a critical factor whereby the process of advancing cultural intelligence and international cultural competence would be the deciding element for the success of managers and leaders especially those who perform human resource (HR) functions. Within the cultural context, common elements are to be found including shared and dynamic nature surrounding norms, values and beliefs which are expressed through different behaviors, artifacts and interactions. It is necessary then for HR managers like Wolfgang to fulfill profitable relationships vested on the capability to reconcile cultural dimensions of pay systems from the headquarters to subsidiaries. Within Healthcare, there are economic, political and cultural forces that are influencing the operation. As part of the external environment, there is the need forHealthcare to align national cultural values of thesubsidiaries with that of the organizational work culture. There are culturally indigenous and culturally alien practices within any organization that shape the actions and performance of the employees. Culture is considered as the lens through which motivation occurs. Motivations to do work differ...
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...International HRM ‘Wolfgang’s Balancing Act’ Case Study Task 1 Cultural contingencies that shape employee behavior in Healthcare As the world becomes more interdependent, the business and the process of doing business are exposed to many, continuously changing dimensions, structures and opposing forces. In a global environment, culture is a critical factor whereby the process of advancing cultural intelligence and international cultural competence would be the deciding element for the success of managers and leaders especially those who perform human resource (HR) functions. Within the cultural context, common elements are to be found including shared and dynamic nature surrounding norms, values and beliefs which are expressed through different behaviors, artifacts and interactions. It is necessary then for HR managers like Wolfgang to fulfill profitable relationships vested on the capability to reconcile cultural dimensions of pay systems from the headquarters to subsidiaries. Within Healthcare, there are economic, political and cultural forces that are influencing the operation. As part of the external environment, there is the need for Healthcare to align national cultural values of the subsidiaries with that of the organizational work culture. There are culturally indigenous and culturally alien practices within any organization that shape the actions and performance of the employees. Culture is considered as the lens through which motivation occurs. Motivations to do work differ...
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...Pay Performance and strategies to encourage adoption of EMR ? Pay for performance in healthcare provides financial incentives for healthcare workers like clinician for better healthcare outcomes. These outcomes are longer for survival, are very difficult to quantified and measure, so pay for performance systems usually are method used to measure the outcomes process, for example measuring blood pressure or counselling for patient to quits smoking. According to Mr. Aaron E. Carroll, a pediatric professor who write for the New York Tines, tell after reviewing the medical literature in year 2014 that pay for the performance in US and UK has created a disappointing mixed results. Sometimes even though large incentives it will not change the way doctor practice medicine. Critics say that pay for performance is a method borrowed from the corporate management which the main results or outcomes is for profit. In the practice of healthcare and medicine, many important outcomes and aspects such as spending time with the patient, can’t be quantified measured. Pay for performance is also known P4P’s or value based purchasing this payment method rewards the doctors, nurses, and other healthcare staffs for meeting a certain criterion for quality and efficiency. It penalized staffs or caregivers for poor outcomes, medical errors, and increases cost. Electronic Medical Record (EMR) and pay performance are one of the methods for health reformers to use for improving patient care. It is...
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...Barbara Heard MSN 285637 Mentor: Ronda Arnold March 15, 2015 C159/UUT2 – POLICY, POLITICS & GLOBAL HEALTH TRENDS POLICY ANALYSIS TASK Introduction: This assignment requires that I develop and thoroughly analyze a public policy in order to advocate for one that improves the health of the public and/or the nursing profession globally (local, state, national or international). To do this, I must reflect on several aspects of being a policy maker within the nursing profession. I was instructed to consider the following: · Why did I select the health or nursing profession policy issue? · How does this issue affect nursing practice, healthcare delivery and health outcomes for individual, families and/or communities? · What are the values and the ethical positions that underpin my perspectives? · What criteria will I use to evaluate the success (outcomes) of my proposed policy change? I will use both, a top-down and bottom-up approach, in order to analyze and bring the nursing perspective to policy makers and stakeholders. By identifying the values and ethical perspectives that underpin my position, I will develop criteria to evaluate the success of my work which will lead to the creation of a policy brief that can be sent to decision makers and create a plan to work with an organization/community to promote policy change at the local level. Nursing research to support my position is vital in guiding me to my conclusion and will include principles of...
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...Conclusion of the Research Process to Problems in Health Care Ijuanaya Woods HCS/465 April 22, 2013 Kerrie Kelly o Results In the world of healthcare, there are many advantages to improving the quality of healthcare while keeping the costs of healthcare down. One system is known as the “Pay for performance” system. This system is aimed at improving healthcare by offering a financial reward. This type of program usually pays a bonus if the providers or hospital meet on an agreed upon performance measure, for example, reducing the hemoglobin A1c in diabetic patients. Hemoglobin A1c is a test that shows the average level of blood sugar in a patient within the past 2-3 months. This is important for diabetic patients to see whether their blood sugar levels have been on target or not. These incentives can be paid directly to physicians, hospitals, and other healthcare providers to ensure that their facility carries out such improvements and to achieve the most optimal quality of care for their patients. Another system is called “pay for performance”, where paying providers for resulting in better outcomes for patients, who in return will improve these outcomes. While both of these programs are a great way to improve the quality of healthcare by giving providers some type of motivation to improve their services, it can also come with some penalties. Hospitals and nursing homes can face financial penalties if their patient becomes ill...
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...how well BWI HR is meeting the needs of its employees. Fifty surveys were collected and reviewed. One each survey were eight HR services. The HR services are Performance Appraisal, Wage & Salary Administration, Incentive Pay Program, Internal Job Posting, Healthcare Insurance, Technical Training, Career Counseling/Development and Flexible Work Schedule. Each of the HR services had a rating scale to see how important and satisfied the Target employees would rate them. There were three HR services that showed the largest gap between importance and satisfaction. The incentive pay program, performance appraisal system and career counseling and development all showed large negative gaps. The incentive pay program should be changed from an individual-based program to a team/group-based program. The performance appraisal system should evolve into a “social network” type of performance management system. This type of social performance management system will bring many advantages, including empowerment. Finally, the career counseling/development programs should see a small expansion and reviews of the eligible degrees, adding certificates, increasing the tuition reimbursement amount and adding mentoring programs. These improvements should be implemented to improve the HR services, our people and our overall company performance. Introduction The HR department is proud to provide a wide array of services to our excellent people that make this company great. As the needs...
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...HMA1: Trends in Healthcare Western Governors University Healthcare Management Case Study HMA1 Linda Gunn August 21, 2010 HMA1: Trends in Healthcare The American healthcare system is in the midst of change. No other time in history has the call for healthcare reform been so strong. It is the emergence of expensive new technologies with an aging population and a new call for equitable quality access of health services for all citizens that have pushed for the impending change. Successful managers will need to understand the impetus for this change. The challenges will provide many opportunities for a manager that is properly prepared to lead and guide their organization. Model trends in the United States. Historically, the United State’s healthcare system has been provider dominated. Physicians ordered and directed care without concern for cost or resources. While complex and ever-changing, the focus was on treatment of infectious diseases such as polio, influenza, small pox. (Shortell & Kaluzny, 2006) Our current model of healthcare places much of the responsibility and burden of the cost of medical care on the individual. American healthcare spending approaches 17% of our gross domestic product (GDP), the highest of any member of the World Health Organization. Our performance consistently underperforms in comparison to our peer nations in such measures as life expectancy, infant mortality and overall level of health. (World Health Organization [WHO], 2000) ...
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...Pay for Performance The concept of Pay for Performance (P4P) was developed over 30 years ago in an effort to provide incentives for healthcare services to the provider contracts for improved performance. This strategy involved integrating quality measures and efficiency incentives into healthcare and decreasing misuse and increasing utilization of resources. The most important point of P4P is to understand that this program is based, first and foremost, on the clinical performances hospitals, physicians and other healthcare professionals and are predominantly focused on evidence-based clinical practices and patient safety programs and procedures. The definition of “Pay for Performance” is described as a method of incentive payments for the...
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...000 people sign up for the Affordable Care Act (ACA) (arisecitizens.org). This shows that there is a need for healthcare coverage within this state. However, with this increase in people inundating the system, there could be a possible rise in cost. Specifically, there could be a rise in Medicare. This program was signed into law on July 30, 1965 (SSA.gov). It is designed to take care of the elderly at 65 years and older, certain individuals who are disabled, and people who have kidney disease (CMS.gov). Even though this program is not income specific, it does help more low income people and individuals who have bad health issues and it is also a target for political battles (Tietelbaum & Wilensky, 2014).There are Republicans who are opposed to Obamacare and want to run Medicare their way. Then there are Democrats who want the program ran another way. They are in favor of Obamacare and see a positive outcome now and in the future. As for the public, the divide among politicians is equally the same amongst Americans. There are individuals who are in favor of Obamacare and there are others who are opposed to it. There are the hospitals and its doctors and staff who will be affected through the number of patients seen and Medicare payments, to name a couple. Overall, Obamacare gives consumers the power to regulate their own healthcare needs (hhs.gov). It allows healthcare beneficiaries...
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...Pay for Performance Incentive Programs in Healthcare: Market Dynamics and Business Process Executive Briefing AUTHOR Geoffrey Baker, MBA President, Med-Vantage® Inc. 1 California Street, Suite 2800 San Francisco, California 94111 CONTRIBUTORS John Haughton, MD, MS Founder, DocSite LLC 540 Main Street Winchester, Massachusetts 01890 Peter Mongroo Director, Healthcare Industries Markets Oracle Corporation 500 Oracle Parkway Redwood Shores, California 94065 A Research Report sponsored by ViPSSM, Inc. in partnership with Med-Vantage® 2003 Table of Contents Introduction.......................................................................................................................2 Goals and Motivations behind Pay for Performance..................................................................4 Market Adoption .................................................................................................................5 Funding and Incentives .......................................................................................................7 Measuring Performance: Physicians and Hospitals..................................................................10 P4P Operations and Business Processes for Health Plans.........................................................12 Key Lessons Learned and Critical Success Factors ..................................................................14 Conclusion...........................................................
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...Summary of the case “Wolfgang`s balancing act” Wolfgang Hansen, Healthcare`s new HR manager, is required to revise existing HR policies and strategies as well as the company`s global payment system. Within recent years Healthcare has been undergoing a great level of expansion, meaning that HR strategies need to be revised and adapted accordingly. Originally business processes were locally oriented though nowadays the company is aiming to develop a more transnational strategy by globally integrating operations while leaving room for local responsibilities. One of Wolfgang Hansen`s current tasks is to decide which HR practices to globally standardise and which HR practices to locally customise, such as in the case of remuneration. Healthcare`s new HR manager has realised for example that variable pay is not appreciated by every country in the same way (USA vs. Japan) and as such existing pay elements need to be revised. On the other hand locally adapting variable pay can actually lead to complications, such as supervisor biases or unfair performance measures. As such it is proposed that Wolfgang Hansen should rather concentrate upon “rates of return” by employee (performance + time spent at company) instead of locally adapting variable pay. Further it will be vital for the HR manager to clarify existing pay elements. A problem that could arise is the feeling of inequity if a group, division or unit receives similar financial rewards. As such it is proposed to also develop individual...
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...with its existing workforce crisis in the healthcare system? Number of uninsured Americans has significantly increased, mainly due to aging population and income change. The prevalent issue of America’s healthcare system is insurance coverage, access to healthcare. Americans believe this issue should be prioritized, and it is the direct responsibility of federal government to ensure medical care for those citizens that lack insurance. This essay include history of United States healthcare system, its evolution and how healthcare providers can contain costs of healthcare and provide quality and access to healthcare for everyone. From the beginning of 2014 Affordable Care Act by Obama government is trying to solve the enduring issue of American healthcare system. It is a step in the right direction but this reform is facing lots of resistance from Republican Party, that this reform will put country in debt stress. Many Americans are concerned with quality and access to healthcare with the influx in number of insured entering the healthcare system which is already facing the workforce crisis. United States Health care History Healthcare in United States is enduring issue and it is very sensitive subjects for Americans. United states from the beginning choose a market approach to medical care. Medical care is as a market commodity, that you could buy or sale rather than as a social good available for all. In America healthcare is treated as private consumer good and is...
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...place in the transportation market in Austin, Texas. Market Research Evaluating companies in the relevant market will keep you competitive. We have researched 2 established car service companies in Austin, Texas operating with 25 employees or less. We started with a company you may be familiar with. Founded in 1989 by Tony Alyassin, Royal Carriages Limousine operates a substantial fleet of more than 25 vehicles (http://royalcarriages.com/). Employee are independent contractors with a compensation package of a flat wage rate and a corporate contribution to the National Taxi Drivers Association of Austin. The National Taxi Drivers Association is an organization that was founded in 2009 that focuses on taxi and limousine driver issues like healthcare for drivers, state regulations, and safety for professional drivers. The NATD points out that the nearly 250,000 taxi and limo drivers in the United States have been one of America's most overlooked groups of independent contractors. The organization is not a union or advocacy group, but claims to be "a source of information and products to improve drivers'...
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