...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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...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 University of Phoenix Lori Stemen October 28, 2013 Reimbursement and Pay-for-Performance The United States has gone through some dramatic changes over the last forty years and currently we are in the middle of some additional changes with the Affordable Care Act. Pay-for-performance is intended to improve the efficiency, quality, and the overall worth of health care. The expectation is that these changes will provide to physicians, hospitals and other health care providers with financial incentives to finance improvements and accomplish improved results for the patient. There are positive and negative affects of the pay-for-performance programs, although we can’t predict the future and the outcome of these initiatives, the health care system will definitely feel the pressure to perform with respect to outcome accountability. With the continuous changes of government regulations the pressure to provide reliable high quality health care will increase. Pay-for-performance is the newest regulatory effort in health the insurance industry. Health care providers who participate with the insurance carrier are compensated for meeting pre-set goals for how they deliver health care services. This is an important modification from the fee for service method of payment. Pay-for-performance has been well liked by politicians as well as, Medicare, Medicaid and private insurance companies. The Affordable Care Act increases the usage of...
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...Pay-for-performance and Reimbursement Jason Teker HCS/531 May 2, 2016 Georgetta Baptist Pay-for-performance and Reimbursement Health care is in the middle of a change in how payment is received for services provided. Fee-for-service is the dominant form of reimbursement for hospitals and doctors. According to Medicaid’s website, the fee-for-service payment model is structured so that there are incentives in place based on the number of services provided. Fee-for-Service models allow for a system where quantity is more important than quality. With rising health care costs, the federal government is looking to change the way hospitals and doctors are reimbursed for their services. Quality health care is becoming a hot topic in many realms of the health care industry. The government has proposed a new form of repayment in a system called Pay-for-performance which was brought to the forefront of policy agendas by the Institute of Medicine’s (IOM) report in 2000 titled To Err is Human (Mayes, 2006). In the report, the IOM estimated “as many as 98,000 patients die annually in U.S. hospitals due to preventable medical errors” (Mayes, 2006, p.17). Pay-for-performance is “a reimbursement method under which some physicians and hospitals are paid more than others for the same services because they have been deemed to deliver better quality care and their patients appear to have better outcomes” (Mayes, 2006, p.17). With this new reimbursement method, the incentives are now...
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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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...Reimbursement and Pay-for-Performance Tessa Zendner HCS/531 March 2nd, 2015 Georgetta Baptist Reimbursement and Pay-for-Performance Pay-for-performance programs have changed the way physicians provide care in many sectors of the health care industry. They impact reimbursement, especially in regard to Medicare and Medicaid. Pay-for-performance has effects on both the quality and efficiency of health care delivery, although its overall impact it a matter of debate. There are studies that show improvement in quality of care in some areas, and others that show no difference in outcomes. There may even be negative repercussions and ethical issues stemming from the enactment of these initiatives. The goal will be to revise and adapt the system within the evolving health care landscape in order to provide the best outcomes possible for both providers and consumers. Pay-for-performance Pay-for-performance is an incentive program defined by the Health Care Incentives Improvement Institute as, “a term that describes health-care payment systems that offer financial rewards to providers who achieve, improve, or exceed their performance on specified quality and cost measures, as well as other benchmarks” (Pay for Performance, 2012). Pay-for-performance has become a popular tool to attempt to improve quality and efficiency in health care. It is becoming more widespread with the enactment of The Patient...
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...Findings 5 Stock Options 5 Tuition Reimbursement 6 Merit Plans 7 Conclusion 8 References 10 Executive Summary In a business the main focus is become as successful as possible. In order to gain success and maintain the success a business must have a reliable and dependable staff. With this being said it is important to compensate employees to maintain and develop the best work performance possible. The success of the business is depended on the employees. Research has been done on three compensation strategies that benefit the employees and company, those three compensation strategies are implementing stock options, tuition reimbursement, and merit plans. Stock options benefits have been known as an attractive way to reward employee performance. It is important for the organization to claim the stock options to be capitalized on the balance sheet so shareholders can track EPS, which in return is beneficial to the organization as well. This compensation benefit has been around for decades and continued to grow until the increase in accounting rules in 2001. With more rules implemented it allows for the companies to maintain a fairness in the workplace. This option should be offered to all employees but is not require for the employee to exercise. The beginning step to be made for the organizations is to determine at what price the employee may purchase stock options at and for what timeframe. Tuition reimbursement has been shown to benefit employees’...
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...Pay-for-performance Reimbursement and pay-for-performance are the heart and soul of every organization. Without money flow into the health care system, it is hard to pay for the services offered to individuals. Client has to pay for the health care services utilized in one way or other. Health care system is growing in a faster pace with than the economy in the United States. The various reasons are technology proliferation, new medications in business, research studies, advances in devices, and new procedures. On the other side, there is widespread concerns about the medical errors, inconsistent quality in health care services, increase in cost, and public awareness about the health care services through Medias, led to the movement of pay-for-performance. This emerged as a cost containment program. Health care system is trying to provide quality, efficiency, accountability, and transparency in health care services through the development of pay-for-performance movement (Henley, 2005). Pay-for-performance refers to the financial incentive program that pay a bonus to the participant of services such as physicians, hospitals, physician groups, or health plan groups who attain a benchmark in quality, efficiency, accountability in health care services and in patient care. This is referred as the pay-for-performance movement. This program provides high credit bonus for preventive care services. As the term indicates, "pay-for performance" is the high quality health care services...
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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 HCS/531 March 25, 2013 Reimbursement and Pay-for-Performance With health care reform taking full effect, various changes are emerging with regard to health care provider reimbursements. Third-party and government payers are rapidly moving toward pay-for-performance approaches that emphasize the quality rather than the quantity of health care services. Pay-for-performance initiatives have the capability of significantly impacting reimbursements based on whether or not and to what extent certain performance outcomes are met. At the same time, health care providers and consumers are both positively and negatively affected by pay-for-performance programs. While the future of pay-for-performance programs is unknown, it can be assumed that health care providers will likely carry increased pressures with regard to outcome responsibilities. With the continual addition of regulations set forth by the Centers for Medicare and Medicaid Services (CMS), demands to consistently provide high-quality care will increase. Pay-for-Performance Pay-for-performance is a payment model that rewards physicians, hospitals, medical groups, and other healthcare providers with financial incentives based on performance on select measures (Epstein, 2012). These performance measures can cover various aspects of health care delivery including: clinical quality and safety outcomes, efficiency, health care access and availability of care, patient experience and...
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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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...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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...strategy including tuition reimbursement, bonus and paid time off. They are valuable programs and creating attraction process for most common compensation programs. These strategies are useful tool to improve employee satisfaction and work ethics. But, used incorrectly, it can cause some financial damages and relation disconnect between company and work forces. Bonus, tuition reimbursement and paid time off can be created to reward individual performance which is related to company’s mission and building trust in the organization. Company can use these strategy tools to communicate a fresh commitment from the employer to the employees and remind workers how much they are appreciated. The purpose this report is to determine the proper amount of compensations gets applied for different jobs in the organization. The organization because persuading the incorrect determination can cause bad implications for the company and damaging the work ethics of the employee organization as well as the employer’s power to hire qualified employees. Another purpose of the research report Well treated employees make a major role in a company’s power to improve its product quality, services and make a profit, so attracting employees can be a main key to success. Making a decision about compensation is also affecting the organization financial plan as well. There is very close relationship between compensation plan and the performance measurement, especially when pay salary is depend on the individual’s...
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...Stakeholders Bangor Family Physicians is a partner based medical group practice located in Maine. The practice consists of four family practice physicians, and a medical support staff. The medical support staff is made up of a practice manager, two receptionists, four nurses, two medical assistants, two billing clerks, and a laboratory technician. Additionally, Bangor Family Physicians employs a CPA to assist with taxes and financial advising. The key stakeholders are the four family physician partners, in which each physician holds an equal stake in the practice. Bangor Family Physicians Reimbursement There are two determinants to reimbursement for Bangor Family Physicians: a monthly salary and yearly profits after accounting for reinvestments into the company. Since the foundation of Bangor Family Physicians in 1986, the practice has used an equal pay compensation model as the reimbursement scheme of choice. Profits that are above overhead costs at the end of the year are portioned out equally to each partner, thus determining the overall amount the physician receives for the year. While this type of compensation model discourages overutilization and allocates risk among all physicians, it negatively affects productivity and does not reward efforts to improve quality. Such a system can only work on the basis that all physicians have the same skill and productivity levels and are equally motivated to contribute to the practice. In Bangor Physician’s situation, each physician...
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...Tuition Reimbursement Vanessa Lewis XCOM 285 09-04-2011 Suzanne Delger Tuition reimbursement is a good way to attract employees that are looking to further their education. Companies see it as an opportunity to retain their employees and increase job performance and loyalty. In order to get what you want you have to give them what they want. However, it is really up to the employee if he or she stays with the company once he or she has earned their degree. There are many things that we have to look at when it comes to tuition reimbursement because it may help a company meet their short term turnover goals, but really could go either way. Most want to better themselves in some way; tuition reimbursement encourages those that are unable to pay for college. It is easier to make that choice when employees know there is financial help available. Also, knowing that they can then move forward in the company helps the employee and the employer. As adults, one has to work and someone can come in do the same job that you do and make more money than you do just because they have a degree to go with their skills. When most employees even think about pursuing a degree, it is because they are looking for more income. Having a degree opens up the door for employees to earn more money on the job that they already love. On a weekly basis, someone with a high school diploma, on average, earns $507. Some one with a bachelor’s degree, on average, earns $834 a week, a master’s...
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