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Reimbursement and Payment

In: Business and Management

Submitted By bandit1966
Words 1751
Pages 8
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 in preventive and chronic care. As with any new program or idea, pros and cons exist. Benefits to using P4P are that insurance companies and individuals will receive better quality care at reduced costs. Disadvantages of P4P include how costs or savings will be measured, how to determine the incentives or penalties for each level of care as well as how to determine quality of medical care from...

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