Hospital administrators must take into consideration the role of reimbursement by health insurance companies when allocating finite resources and in assessing how patients will evaluate different treatment options. One of the most common examples of this is the rise of pay-for-performance incentives. “A pay-for-performance program provides a bonus to health care providers if they meet or exceed agreed-upon quality or performance measures, for example, reductions in hemoglobin A1c in diabetic patients” (“Pay For Performance,” 2012, par. 9). The underlying concept behind pay-for-performance is that rather than encouraging providers to offer more tests and treatments that may be unnecessary, providers are instead rewarded for patient improvement, including making diabetic patients less rather than more dependent upon medications. Pay-for-performance is used to encourage wellness promotion and to encourage treating chronic conditions before they require expensive tertiary-level interventions. “For example, the Medicare program no longer pays hospitals to treat patients who acquire certain preventable conditions during their hospital stay, such as pressure sores or urinary tract infections associated with use of catheters” (“Pay For Performance,” 2012, par. 10). Hospitals must effectively pay for their own mistakes, under such revenue reimbursement structures, theoretically discouraging errors. While the advantage of pay-for-performance from the patient’s perspective is that more patients do not automatically generate more revenue, thus encouraging a manageable patient load, there are also concerns that certain types of patients, such as the very sickest...
Physicians believe that this straightforward model places the maximum trust in their expertise as providers (“What Payment Models Exist,” 2017). The trouble with such a model is that it encourages more rather than less utilization of services. From a macro level perspective, pay-for-performance might seem to be superior to keep costs down and to maintain high levels of quality. Other common models include episode-of-care payments, in which “bundled payments reimburse healthcare providers for specific episodes of care such as an inpatient hospital stay,” leaving only “a set amount of money to pay for the entire episode of care” (“What Payment Models Exist,” 2017, par. 4). Arguably, this may discourage provision of needed services. However, given that even if the patient might require more services, there are no available funds, concerns arise that rationing must be used by the institution, which can impact quality of care.References
Pay-for performance. (2012). Health Policy Briefs. Retrieved from:
http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=78
Reardon, S. (2015). What are the challenges of medical bill collection? Revcycle Intelligence.
Retrieved from: https://revcycleintelligence.com/news/what-are-the-challenges-of- medical-bill-collections
Riley, J. (2015). Maximizing reimbursement starts with patient access. HFMA. Retrieved from:
http://www.hfma.org/Content.aspx?id=27386
What payment models exist? (2017). McKesson. Retrieved from:
http://www.mckesson.com/population-health-management/resources/what-payment- models-exist/
Healthcare Economics Overall Healthcare And Economics Healthcare economics: Current challenges from a nursing perspective Although the subject of healthcare economics has been hotly-debated, on one issue there is widespread agreement: the aging of the population will substantively increase the demand for healthcare in the near and far future. As the population worldwide is aging and living longer, the need for essential services over a longer lifespan will generate more costs for an already-beleaguered
Therefore in the economic sense many institutions have been viewed to lay back. Knowledge and Expertise in Telemedicine Another challenge has to do with the limited knowledge and expertise in telemedicine as well as the need for enhanced and modified telemedicine systems. In this sense, little knowledge currently exists among medical practitioners on how to effectively and practically use various forms of telemedicine. This knowledge gap on insight into telemedicine, in
Healthcare Quality Measurement Compare one measurement that you identified in the Week 2 Discussion with one measurement outlined by the CMS restricted reimbursements and explain how these two measures demonstrate evidence of compliance with their respective quality measurement standards. In the Week 2 Discussion, we considered the importance of personnel-focused quality measures in rating healthcare performance. The Centers for Medicare and Medicaid Services (CMS) maintain a wide range of these measurement types.
Health Care Economics In economics, cost-benefit analysis assists in evaluating the costs of an approach in terms of resources spent while cost-effective analysis evaluates the costs as achieving some sort of benefit which is not evaluated in monetary terms. Moreover, cost-benefit study examines several aspects including net-present value, present value of benefit, and present value of costs; in line with this, if a project indicates that the monetary outcome is greater
Health Care in the U.S. And Spain What Can the U.S. Learn About Health Care from Spain? In 2009, Spain's single-payer health care system was ranked the seventh best in the world by the World Health Organization (Socolovsky, 2009). By comparison, the U.S. health care system ranted at 37 (Satiroglou, 2009). The Spanish system offers coverage as a right of citizenship that is constitutionally guaranteed. Spanish residents pay no expenses out-of-pocket, with
097 United States 0.109 0.093808 0.036112 0.068 Utah 0.1071 0.1401 0.035696 0.073 Vermont 0.1326 0.0988 0.040851 0.114 Virgin Islands NA NA NA Virginia 0.1048 0.0829 0.080009 0.092 Washington 0.1229 0.0669 0.027831 0.068 West Virginia 0.1293 0.0774 0.036499 0.055 Wisconsin 0.0954 0.0357 0.032367 0.097 Wyoming 0.1251 0.1453 0.053867 0.075 Notes All spending includes state and federal expenditures. Growth figures reflect increases in benefit payments and disproportionate share hospital payments; growth figures do not include administrative costs, accounting adjustments, or costs for the U.S. Territories. Definitions Federal Fiscal Year: Unless otherwise noted, years preceded by "FY" on statehealthfacts.org refer to the Federal Fiscal Year, which runs from October 1 through September 30. for example, FY 2009 refers to the period
Our semester plans gives you unlimited, unrestricted access to our entire library of resources —writing tools, guides, example essays, tutorials, class notes, and more.
Get Started Now