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Reimbursement and Pay for Performance

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Reimbursement and Pay for Performance
Kristi Thomas
Health Care Organizations and Delivery Systems HCS/531
August 11, 2014
Nita Magee-Cornelius

Pay for performance is a slogan that is used lightly in 2014. It seems to be a no-brainer, when we pay for services we pay for quality and not quantity. It is a bit more complex than that. The slogan actually is a reimbursement or initiative program that provides financial incentives to hospitals, physicians, and other health care providers to make improvements to and achieve optimal outcomes for their patients. The outcomes are measure and some health care providers are paid more because they are deemed to have delivered better service or their patients appear to have better outcomes. There is a controversy amongst intellectuals that ask the question “How can the quality of care be measured?” The idea behind pay for performance is simple; we will give providers more money to achieve a goal. This paper will discuss how reimbursement is affected by this pay for performance initiative, how system cost reductions can impact the quality of care, how pay for performance can affect the provider and what type of effect it will have on the future. In the following paragraphs it will be discussed whether or not reimbursement is affected, how the system costs reductions impact the quality and efficiency of health care, how pay for performance affects the health care provider and their customers and the effects that the pay for performance phenomenon will have on the future of health care. How is reimbursement affected by the pay-for- performance approach. Reimbursement is affected by this initiative when the policy maker, private and/or public payers fail to achieve the specific goals that have been set. The plans are put in place and are acclimated to each health care facility. For example, the pay for performance program

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