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Reimbursment

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Reimbursement and Pay-for-Performance Paper
Patricia Vandermark
HCS/531
November 3, 2014
Connie Melton

Reimbursement and Pay-for-Performance Paper
The arena of health care has always been constantly fluid, dynamic, and extremely challenging. As health care providers we struggle with the increasing demands of our institutions, the increasing demands of our patients, and most recently the demands that are a direct result of today’s health reforms. Since the inception of The Patient Protection and Affordable Care Act (ACA) of 2010 (Obamacare) our health care system has been challenged with the demand to improve health care quality and patient satisfaction while reducing costs. The United States health care system is evolving from a fee-for-service to a fee-for-outcome or pay-for-performance model. Not since Medicare and Medicaid were signed into law in 1965 has there been such a significant overhaul of our health care system. In this paper, I will discuss the "pay-for-performance" strategy and how it is intended to improve the quality and efficiency of health care.
Definition pay-for-performance
"Pay-for-performance" is an umbrella term for initiatives aimed at improving the quality, efficiency, and overall value of health care (Robert Wood Foundation, 2012). Financial incentives are offered to hospitals, physicians, and other health care providers and facilities if certain predetermined quality or performance measures are met. The pay-for- performance model also may impose financial penalties on facilities and providers that fail to meet the predetermined goals. Pay-for-performance has become extremely popular with policy makers and political leaders, among them being Medicare and Medicaid. The Affordable Care Act expands the use of pay-for-performance approaches in Medicare in particular and encourages experimentation to identify designs and programs that

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