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Pay-4-Performance

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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 based on the quality of care given instead of on the quantity of services a patient receives. This new system will have a ripple effect on all aspects of health care from reimbursement payments to the effects on physicians and hospitals to the future of health care itself.
The government has two primary goals in mind with the implementation of pay-for-performance. First, they want to

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