Question

Using Internet, review at least two articles for each topic and write a review for each source of information. Use the following guidelines for developing your essay: Write a summary for each topic tying together the information learned about that topic. Analyze the market forces that would favor using one reimbursement method over another. Evaluate the key differences between different types of payment methodologies from the provider and hospital point of view. Evaluate the advantages and disadvantages of the payment methodologies reviewed from the provider and hospital point of view. Evaluate new payment methodologies resulting from the Patient Protection and Affordable Care Act (PPACA) and discuss future changes in reimbursement methodologies. Compare and contrast each article to the information discussed in the course textbook.

Answer 1

Payment methodologies:

• Fee for service.
• cost based payment
• prospective payment
• percentage of charge
• .per diem
• per discharge
• diagnosis related groups

COST BASED PAYMENT:

It is a reimbursement method. Payment is made after the service is rendered to the patient in a health care facility. It is a settlement process.

It requires some form of documentation.There is a risk because if any malpractice in documenting happens it may affect the patient , service provider. This system risks provider.

PROSPECTIVE PAYMENT:

It is a reimbursement method where payment is paid to the provider before the service is rendered. It is a fixed amount .If the care provided is not good no cash back is provided. In this payment system the patient is at risk.

PPACA - according to patient protection and affordable care act  health coverage is made more fair and easy to understand, along with subsidies.

New methodologies are

• Bundled payment
• Shared savings
• Pay for peformance
• Patient centered medical home payment

There are still more alternate systems. They are efficient in provision of high quality care.

Future changes in reimbursement methodologies:

Improve coordination between providers

Improve quality of care and outcome

Improve efficiency of care

Evaluation of payment options

Allow for payment flexibility

Payment system should be based on the amount of population in certain area

Digital innovation and IT systems are to be involved