Question

Describe what Pay-for-Performance Healthcare is and talk about it's Pro's and Con's. Explain a couple of different models and share the benefits of each. Do you feel it is something that can help or hurt the overall quality of care given to patients?

Answer 1

Pay- for - Performance health care

The term pay -for - performance in health care also known as value based payment , comprises payment models that attach financial incentives / disincentives to provider performance. It is a part of the overall national strategy to trannsition health care to value - based medicine .While it still utilize the fee -for - service system , it nudges providers toward value based care because it ties reimbursement to metric -driven outcomes , proven best practices ,and patient satisfication , thus aligning payment with value and quality.

PROS AND CONS OF PAY -FOR- PERFORMANCE HEALTH CARE

PROS

1.It takes the emphasis away from the volume of services provided.

if a person goes to the doctor , the variety of services provided to the patient . The reason behind such behaviour is due to the structure of volume service pricing. when medical providers have a financial incentives to provide as many servisces as possible , then it opens the door to patients paying for things that they dont really need to maintain their health and wellness. It focuses on the quality of the care a patient receives , an element that often goes missing when using base payment methodology.

2. It allows medical providers to focu s on specific patient priorities

.3.reports on quality standards is incresing and getting mor accepted by providers and is used more by payers.

4. the public has access to high quality information about th eperformance of providers.Some pay for performance programs keep their results confidential , but most accept that public reporting is the more effective

5. pay for performance for physicains can provide a direct link between quqlity and cost .

6. pay for performance program is working well wellforprimary care servi*ces. when clinical course of action is established and commonly accepted.

7. pay for perfromance systemhas the potential tocombine quality ,cost and accesspurposes in measurethat cover structure,process and outcomes

8. the system incentivizes providers to avoid recurring visits of patients and emphasises more on qulity of care.

9.pay for performance alsoincludes someethicaleasures as well.

CONS

1. It creates a higher level of administrative complexity

2.I t could compromise providers commitmetn to quality

3.I t has several gaps in care that have no known measurable solutions

4.It provides a focus on clinical process measures

5.it relies on documentation for performance

6. it does not take into account the challenges that may be present in some patient populations

7. it may cause professionals toalter their activities

8. it can be challenging to know any existing cause ad effect relationships

9.it may not offer anyincentives toencourage improvement

A Performance model created to define the significant aspects of the way in which a proposed or actual system operates in terms of resources consumed , contention for resources and delays introduced by procesign or physical limittations .

there are several model for pay ment in todays health care system.they are salary , case -based payments , capitation and fee for service.

salary is a fixed paymetn over a specific period of time . Case based payments are payments within a single episode of care , wherein the amount of services required is not reflected by the physicians earnings. Capitation is a set amount for each enrolled patient assigned to a physician or group of physicians , regardless of whether the pateints require assisstance. Fee for service occurs when the physician is paidfor services rendered.

Allof these models have merits but also have hindrances . the salaried physicians may provide better quality of care to their patients because they have more time and no incentives to increase their natural speed .

the case based payments do provide incentives for physicians to see more patiens , but may influence physicians to choose less complex patients in order to increase patient volume.

capitation provides incentive for physicians to takeon more patients and likely decrease the likelihood of physicians providign unnecessar services, but there are again no incentives toprovide care for complex patients .

fee for service provides incentive for physicians to see more patients but also offer more services .

the pay for performance is used to help th patients in over all providing care for the patients