...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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...Reimbursement and Pay-for-Performance Darrick Poole HCS/531: Health Care Organizations and Delivery Systems February 11, 2013 Eugene Burwell Reimbursement and Pay-for-Performance In 2010, health care expenditures in the United States almost reached $2.6 trillion. This was 10 times more than expenditures spent in 1980. The rate of increase slowed in the late 1990s and early 2000s but industry experts still expect the cost of health care to increase more than the national income for some time to come. Stakeholders agree this continual financial burden is of critical importance. During the last decade, the financial woes in the United States caused many people to lose employment and others to work for much lower wages. The effects of the financial conditions increased the focus on health care spending and peoples’ ability to afford health care. The premiums paid by employees for their families increased by 97% putting further strains on employers and their workers. Baby boomers reaching retirement age increased enrollment in Medicare and Medicaid causing strain on federal and state government budgets. In 2010, health care expenditures consisted of 17.9% of the Gross Domestic Product. Over half of the nation’s health care expenditures result from hospital care, physician, and clinical services. One way the Affordable Care Act seeks to address the issues of cost is by reducing the compensation for hospital and treatment services that result in medical errors or inadequate quality...
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...Reimbursement and Pay-for-performance Amy Escobar December 2, 2013 HCS/531 Charles Silveri Reimbursement and Pay-for-performance “Health care and health policy continue to be controversial domestic issues in the United States. Despite a slowing in the rate of growth of annual costs, most Americans feel that their budgets are strained by what they have to pay for health care, and most employers feel that their share of these costs for their employees is excessive. Currently, many Americans still do not have health care coverage” (Shader, 2013). In hopes of diminishing these cost, the United States Congress and President Obama passed a series of laws to help the American public receive the medical care that so needed. As part of these laws came pay-for-performance reimbursement systems. Even though this procedure for payment still has many details to be determined, this value-based payment system can be a response to quality care and performance. Pay-for-performance The newest trend in reimbursing medical providers is called pay-for-performance (P4P). This valued-based strategy allows a predetermined benchmark to be designated for medical care. If the provider meets or exceeds the standard he or she is paid bonuses for such care. If the provider does not meet the standard payment is reduced accordingly or fines may be put into place. The main focus of this form of payment is to reduce excessive medical costs and to increase quality of care of the patient, especially...
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...Pay-for-Performance HCS/531 January 28, 2013 Jody Sklar Pay-for-Performance Emergence of Pay-for-Performance In 2000, the Institute of Medicine (IOM) released the report “To Err is Human: Building a Safer Health System.” The report catalyzed the attention of health care stakeholder groups in the nation (Stafford, 2000). The research provided a comprehensive, detailed account of health care errors and preventable deaths costing billions of unnecessary dollars in a health care system already spiraling out of control. The IOM recommended that Congress create a Center for Patient Safety within the Agency for Health Care Research and Quality for the purpose of designing a safer health care delivery system. Fifteen months after releasing the patient safety report, the IOM released “Crossing the Quality Chasm.” The report framed underlying reform necessary in the current health care delivery system to ensure patient safety. The framework sought to hold providers accountability for the quality of care they deliver. The introduction of the pay for performance (P4P) as opposed to the prior fee for service and prospective reimbursement guidelines induces delivery of care based upon performance measures. Broadly defined pay-for- performance includes any type of performance-based provider payment arrangements, including those that target performance on cost measures (U.S. Department of Health & Human Services, 2006) Reimbursement Pay-for-performance, synonymous...
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...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 Suley Cruz HCS/531 May 25, 2015 Sarah Dunn Pay for Performance Financing is a critical factor in health care delivery. The way health care is financed impacts it’s delivery. The continual increase of health care cost caused health care reform initiatives to control cost to focus on reimbursement models. Pay For Performance (P4P) is an increasingly popular initiative. The use of pay for performance has effects on the cost, quality, and efficiency of health care. This paper will discuss the effects the use of pay for performance has on patients, provider, and the evolution of health care delivery. Pay for Performance Pay for Performance plans were developed in the early 2000’s as a way to control costs. “Pay-for-Performance is a reimbursement plan that links payment to quality and efficiency as an incentive to improve the quality of health care and to reduce costs” (Shi & Singh, 2012, p. 586). Pay for performance is based on the belief that payment incentives will drive providers to deliver better care which will lead to disease prevention or early diagnosis. Pay for performance incentives give providers bonuses for meeting pre determined quality measures. The main quality measures used in P4P are patient experience, process, outcomes, and structure. Defining Pay for Performance Measures Patient experience refers to patients' assessment and satisfaction with the quality of care received, for example, wait time, communication and cleanliness of provider’s...
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...Business Research Report Compensation Strategies Student Name: Shannon Prazen Table of Contents Executive Summary 3 Introduction 4 Research Findings....................................................................................................................................4 - 7 Finding Number 1………………………………………………………………………………………………………………………………4 - 5 Finding Number 2……………………………………………………………………………………………………………………………….5 - 6 Finding Number 3……………………………………………………………………………………………………………………………….6 - 7 Recommendation…………………………………………………………………………………………………………………………………….7 Conclusion……………………………………………………………………………………………………………………………………………….7 References………………………………………………………………………………………………………………………………………………8 Executive Summary Within this report I have completed research on three additional compensation strategies that have a focus on retaining and recruiting highly qualified employees in the manufacturing field. The additional compensation packages could be implemented into the benefit package already in place for both our exempt and non exempt employees, as well as future employees. The key factor in this report is to battle our problem of employee turnover. While we offer a very competitive wage for a manufacturing company we also need to show that we value dedication and above all pride in a job well done. We need to make sure that we are encouraging the quality of the work performed meet existing standards, and also provides the extrinsic motivation needed to...
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...Linger HCM565-1 Understanding Healthcare Financial Management Colorado State University – Global Campus Dr. Robert Woerner June 5, 2016 Understanding Healthcare Financial Management CHAPTER 1. The Johnson Family Care Inc. (JFCI) is a multi-specialty primary care facility in suburban Pennsylvania. It provides healthcare in an ambulatory setting that provides 24 hour comprehensive care. It recently purchased clinical equipment for their laboratory for approximately $1.1 million and spent $22,000 to renovate and accommodate the equipment. The equipment has a useful life of 10 years after which may be sold for $75,000. JFCI uses the straight line depreciation method to calculate its book depreciation and pays taxes at 40%. The equipment also falls into the seven-year class MACRS structure. 1. What is the annual depreciation expense that will be reported on their income statement for the JFCI organization? 2. What is the annual depreciation expense that will be reported on the JFCI center for tax purposes? 3. JFCI decided to sell the equipment at the end of the 4th year for $400,000, what would be tax implications for LFCI? Understanding Healthcare Financial Management |ANSWER | | | | | |1. | | | ...
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...Pay for Performance Suley Cruz HCS/531 May 25, 2015 Sarah Dunn Pay for Performance Financing is a critical factor in health care delivery. The way health care is financed impacts it’s delivery. The continual increase of health care cost caused health care reform initiatives to control cost to focus on reimbursement models. Pay For Performance (P4P) is an increasingly popular initiative. The use of pay for performance has effects on the cost, quality, and efficiency of health care. This paper will discuss the effects the use of pay for performance has on patients, provider, and the evolution of health care delivery. Pay for Performance Pay for Performance plans were developed in the early 2000’s as a way to control costs. “Pay-for-Performance is a reimbursement plan that links payment to quality and efficiency as an incentive to improve the quality of health care and to reduce costs” (Shi & Singh, 2012, p. 586). Pay for performance is based on the belief that payment incentives will drive providers to deliver better care which will lead to disease prevention or early diagnosis. Pay for performance incentives give providers bonuses for meeting pre determined quality measures. The main quality measures used in P4P are patient experience, process, outcomes, and structure. Defining Pay for Performance Measures Patient experience refers to patients' assessment and satisfaction with the quality of care received, for example, wait time, communication and cleanliness...
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...and deliver healthcare. The Health Security proposal goal was to control cost through competition with a key provision in the proposal known as managed care or competition. This would allow states and employers to work together to make different plans available in return, providing competition among the different providers of the healthcare plans The proposal was also going have large employers pay for healthcare while, small employers would have subsidies provided by the government. The proposal also offered other cost controls and insurance reforms. Many Americans did not like the Health Security proposal because they felt with managed care they would have limited input about what physician...
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...CASE: A-197 DATE: 02/05/09 BAIDU.COM, INC.: VALUATION AT IPO Since its official launch in January 2000, Baidu.com, Inc. (Baidu) quickly grew to become the leading Internet search engine in China. After three rounds of private funding, Baidu registered to go public on the NASDAQ Stock Market (Ticker Symbol: BIDU) on August 5, 2005. (See Exhibits 1 and 2 for a listing of Baidu’s private funding sources and pre-IPO share allocations.) The initial public offering (IPO) turned out to be one of the highest-profile debuts since the Internet bubble burst in 2000. The stock price jumped 354 percent on the first day of trading and closed at $122.54, valuing the company at about $3.96 billion based on 32.3 million shares outstanding. While the market showed strong enthusiasm for the stock, Baidu’s public offering nevertheless generated much debate in the investment community about the underlying value of the firm. Furthermore, concerns were raised about whether or not Baidu was able to sustain its growth rate and exceed investor expectations after the IPO. Factors leading to this uncertainty included: the state of the Internet-paid search market in China, the expected growth in the marketplace, the competitive landscape, and the strength of Baidu’s business model and strategic position. BACKGROUND ON CHINA’S ADVERTISING AND ONLINE ADVERTISING MARKETS Advertising Market From 1995 to 2005 China’s advertising market grew at a compounded annual growth rate (CAGR) of 17...
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...Strategy 1. [pic] INTRODUCTION The name “Baidu”, was inspired by a poem written more than 800 years ago during Song Dynasty whose literal meaning is “hundreds of times”, signifies a persistent search for the ideal[i]. In January 2000, Baidu was founded by Chinese entrepreneur Robin Li (Li) and Eric Xu (Xu) where it conducts its operations in China providing a Chinese Internet search platform through Baidu Online and Baidu Netcom. These companies hold the required licensing and approvals to operate the Company’s websites and advertising services.[ii] Within a few years, Baidu expanded its operations and established three PRC subsidiaries and two other PRC consolidated entities. By January 2008, Baidu launched a Japanese search service with three subsidiaries. To date, Baidu has been the most popular search engine in China and has succeeded in areas where Microsoft and Yahoo have failed: Beating Google at its own game by dominating the search engine market in 2007 with 60.4% market share.[iii] The paper aims to (1) perform an internal analysis on Baidu, to identify the competencies of Baidu; (2) perform an external analysis of Baidu to identify opportunities and threats; and (3) identify business strategies by Baidu and (4) recommend strategic actions to Baidu to compete better in future. INTERNAL BUSINESS FUNDAMENTAL ANALYSIS Organisation Structure and Human Resource Management. Baidu organisation structure works on a functional departmentalisation where...
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...CASE: A-197 DATE: 02/05/09 BAIDU.COM, INC.: VALUATION AT IPO Since its official launch in January 2000, Baidu.com, Inc. (Baidu) quickly grew to become the leading Internet search engine in China. After three rounds of private funding, Baidu registered to go public on the NASDAQ Stock Market (Ticker Symbol: BIDU) on August 5, 2005. (See Exhibits 1 and 2 for a listing of Baidu’s private funding sources and pre-IPO share allocations.) The initial public offering (IPO) turned out to be one of the highest-profile debuts since the Internet bubble burst in 2000. The stock price jumped 354 percent on the first day of trading and closed at $122.54, valuing the company at about $3.96 billion based on 32.3 million shares outstanding. While the market showed strong enthusiasm for the stock, Baidu’s public offering nevertheless generated much debate in the investment community about the underlying value of the firm. Furthermore, concerns were raised about whether or not Baidu was able to sustain its growth rate and exceed investor expectations after the IPO. Factors leading to this uncertainty included: the state of the Internet-paid search market in China, the expected growth in the marketplace, the competitive landscape, and the strength of Baidu’s business model and strategic position. BACKGROUND ON CHINA’S ADVERTISING AND ONLINE ADVERTISING MARKETS Advertising Market From 1995 to 2005 China’s advertising market grew at a compounded annual growth rate (CAGR) of 17 percent, which was...
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...Interprofessional Team Development: A Patient and Family Centered Care Western Governor’s University: C158 May 11th, 2016 Interprofessional Team Development: A Patient and Family Centered Care Approach Approach to patient care has changed over the last three decades from patient treatment-focused model to include comforting, engaging, and empowering patients. The new approach implements patient-centered care environments. It has been adopted by care providers, research bodies, funding agencies, and regulatory agencies, among others. To enhance patient-centered care, business practices, regulatory requirements, and reimbursement regulatory procedures have been adopted. This is evident by the regulations of Joint Commission and the provision of services by Medicare Medicaid services (CMS). In this paper, the impact of business practices, regulatory requirements, and reimbursement procedures on patient-centered care is discussed. A multidisciplinary approach on a process improvement enhancing Patient and Family Centered Focus Care is outlined in a hospital located in Arizona. Regulatory Requirements and Healthcare Business In 1996 the Institute of Medicine took on healthcare improvement to resolve unsafe care by ambitiously moving toward quality initiatives. The release of “To Err Is Human: Building a Safer Health System19 (1999) and Crossing the Quality Chasm (2001)” focused on the fails of the healthcare systems pointing out that over 98,000 patients die in hospitals...
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...Healthcare Information That Helps to Reinforce Career Experience Jennifer A. Dresen Lakeland College Healthcare Information That Helps to Reinforce Career Experience There are a lot of different aspects to look at in the healthcare industry, which can make it feel a little overwhelming at times. The more that I continue to learn, the more comfortable I feel working within this ever changing industry. I currently work for Rehab Management Solutions, which is a practice management company for multiple physical therapy clinics across the United States. In our office we provide services such as; Managed Care, Preliminary Systems, Billing & AR Management, Marketing, and Clinical Growth & Development. A lot of the topics that we have discussed in the course so far I have heard of, but I did not have extensive knowledge of many of them. Below are a few of the topics that I found most interesting and beneficial to my current position and daily activities. Regulation in the healthcare industry There is very heavy regulation for entry into all areas of the healthcare industry. States have set requirements on the licensure of healthcare facilities as well as providers. These mandatory licensures have been set to try and protect the public’s safety, welfare, and health. The provider licensing procedures were put in place to create the minimum accepted standards to be able to practice. Providers such as nurses, doctors, physical therapists, and dentists;...
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