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Reimbursement and Pay-for-Performance

1200 words

Define pay-for-performance. (Pay for results of service provided)
• Explain how reimbursement is affected by the pay-for- performance approach.
• Discuss how system cost reductions impact the quality and efficiency of healthcare.
• Discuss how pay-for-performance affects health care providers and their customers.
• Discuss the effects pay-for-performance will have on the future of health care

Pay for performance in healthcare gives financial incentives to clinicians for better health outcomes. Clinicaloutcomes, such as longer survival, are too difficult to measure, so pay for performance systems usually measure processoutcomes, such as measuring blood pressure, lowering blood pressure, or counseling patients to stop smoking.

o Shi, L. & Singh, D. (2012). Delivering health care in America: A system approach. (5th. ed.). Boston, MA: Jones & Bartlett.



Define pay-for-performance. (Pay for results of service provided)

When assessing the model in healthcare that has emerged as a replacement for the Fee For Service model, (you) must first recognize that this model is not an entirely new concept, but a better version of a revamped system that attempts to ensure that patients receive the most optimal care possible. In this regard, pay for performance (PFP) is a positive approach to healthcare wherein physicians are paid in accordance to their performance with health insurers or other payers such as the federal government offering bonus compensation to physicians for quality performance measures. Evaluations of physician care are placated upon data obtained from physicians and physician groups while also assessing administrative claims data to analyze the quality and/or cost of care. The importance on quality and cost is very important because of the fact that America has the most wasteful, expensive, and inefficient healthcare system while also possessing the best system “money” can buy, which equates to the highest performing physicians and equipment for those who can afford these luxuries. This approach attempts to level the playing field by ensuring that patient satisfaction data is included into assessments to ensure that physicians are analyzed based upon actual performances in collusion with payer’s benchmarks and criteria. Those physicians who meet the payer’s targets may receive perks such as bonus payments.

Typically, a pay-for-performance program will entail a bonus that allows healthcare providers an opportunity to be compensated for positive performances that meet or exceed agreed-upon quality or performance measures. This is done to ensure that patient outcomes are improved and physician performance improves over time with some typical performance measures that are used entailing year-to-year decreases in the rate of avoidable hospital readmissions. One of the more authoritarian aspects …




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