Literature Review: Economic Credentialing
With declining reimbursements and ever-increasing competition by privately owned specialty hospitals and ambulatory surgery centers, hospitals are employing new strategies in attempt to restrict physician competition. One of these tactics is economic credentialing. Physician credentialing is usually a product of qualified and objective peer review when quality of physician competence, quality of care and professional conduct are considered. According to American Medical Association’s definition, hospitals that engage in economic credentialing use “economic criteria unrelated to quality of care or professional competence” to evaluate their medical staff and grant or terminate medical staff membership and privileges. The credentialing process is then reduced to business decision, instead of professional evaluation based on medical standards. The initial goal of this literature review was to examine and discuss possible legal ramifications of these measures, however more thorough study of the available literature revealed additional issues that deserve to be discussed, such as definition of the term “economic credentialing” itself, different forms of economic credentialing policies or the future of economic credentialing in the context of the passage of the Patient Protection and Affordable Care Act.
While most authors generally accept the definition of economic credentialing as outlined by the American Medical Association, Locke Nagele (2003) disagrees. Unlike other authors Nagele believes that there are virtually no instances in which economic criteria that are considered are completely unrelated to quality concerns when viewed as a whole. She sees the main difference between traditional a...
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...importance of controlling utilization of services, quality and cost. The authors anticipate that these changes in the healthcare environment will make identifying and obtaining an optimal mix of physician members crucial for the financial success of an ACO and that it will be achieved by the means of economic credentialing. They point out that these measures that combine pure economic criteria with quality of care considerations are in alignment with policies of the Joint Commission on Ongoing Professional Practice Evaluation that require for example utilization reviews of the physicians. Wright and Drutchas don’t rule out physician support of these policies, if they are applied fairly. After all, the incomes of the ACO and all its members will hinge on the physicians and overutilization by several members could result in significant losses for all involved parties.
Blomqvist A., Busby C., (2012). How to pay family doctors: Why “pay per patient” is better than fee for service. C.D. Howe Institute Commentary, Commentary 365.
During the process of this research paper this semester sources we have been using different sources to create a strong argument and support my point of view regarding Mexican businessmen in El Paso. Among the sources we are using, primary and secondary, historian Mario T Garcia’s book, Dessert Immigrants: The Mexicans of El Paso, 1880-1920, is one of them, and most likely, the most important. The book was published on September 10, 1982. The book is an exceptional work dealing with details, statistics, and historical events related to the Mexican journey to the United States. In his book, Garcia spent an entire chapter talking about obreros y comerciantes (labors and merchants) and what their economic activities were in order to support their dream of getting enough money in the United States and come back to Mexico afterwards.
The twenty-first century has become a very market-driven place and health care is at its highest in demand for adjustment. In exertion to assist with this modification, the case study by Hill Physicians demonstrates an effective innovation pay-for- performance-incentive model for improved quality in health maintenance. In this subject field, Hill Physicians proves that engaging health information technology, innovative care management methods, predictive modelling, and financial incentives will provide higher quality and more efficient care. In this article, however, I will concentrate on two specific ethical issues connected to financial compensation and fairness in health maintenance. To achieve this aim, I will first discuss
Healthcare payers agree with the idea of Evidence-Based Medicine (EBM) to advocate for pay-for-performance in provider reimbursement on quality and efficiency. The fundamental system that most payers use to compensate physicians and provider associations embodies enticements for excellence and efficiency. Reimbursement can be affected by the P4P approach and other factors such as the claims process, out-of-network payments, legislation, audits and denials. While the same P4P approaches are attempts to commence incentives and new strategies into the healthcare, the underlying arrangement of the compensation system produces many per...
The purpose of this study is to examine the cost effectiveness of mid level providers, such as physician assistants, compared to physicians. In order to thoroughly evaluate the difference in cost one must look at more than one aspect of the physician assistant versus the classic physician. From a purely economic standpoint one needs to address the cost of education, differences in the way patients are treated based on the kind of medicine practiced and the cost of employment between physician assistants and traditional physicians.
Cuellara, A. E. & Gertlerb, P.J. (2006). Strategic integration of hospitals and physicians. Journal of Health Economics, 25(1), 1-28. Retrieved February 21, 2011, from http://members.cox.net/mshachar/Cuellar_2006_via_TUI.htm.
Just as the economy travels through its cycles, from bear to bull and back again, so does the number of doctors in the country. In the 1960s, the government began an attempt to create more physicians using various methods. One such method was to reward medical schools for training a certain number of doctors (Bernstein 1013). This would give the medical schools an incentive to accept more students and to allow the students to fully graduate and go on to attend residency programs. Another such method was to give a monetary reward to residency programs for providing graduate medical education. This totaled approximately $7 billion, a sum large enough to “pay the tuition and living expenses of every medical student in the United States” with a large portion left over as well (Bernstein 1013). Because of these actions taken by the government, many more physicians were created, causing a physician surplus throughout the 1980s to the late 1990s, although this claim was based on ...
The current health care reimbursement system in the United State is not cost effective, and politicians, along with insurance companies, are searching for a new reimbursement model. A new health care arrangement, value based health care, seems to be gaining momentum with help from the biggest piece of health care legislation within the last decade; the Affordable Care Act is pushing the health care system to adopt this arrangement. However, the community of health care providers is attempting to slow the momentum of the value based health care, because they wish to maintain their autonomy under the current fee-for-service reimbursement system (FFS).
The early parts of this era also, witness the credentialing requirements of the various HMOs across the nation. For example state licensures were mandatory while federal qualifications were regarded as a voluntary act by the HMOs, however, it was in the best interest of the HMO’s to obtaining the approval of the federal government (Fox & Kongstvedt, 2015; Kongstvedt,
The current set up does not give them the rewards they properly deserve. In fact, the prospect of a limited income is completely unavoidable. These medical doctors are also small business owners. First, they invest an enormous amount of money for office space, office equipments, and medical equipments. Second, the additional burden of overhead expenses and personnel salaries will put a dent on their bottom-line. Third, the inescapable specter of malpractice insurance premiums is a necessary evil the...
The balance between quality patient care and medical necessity is a top priority and the main concern of many of the healthcare organizations today. Due to the rising cost of healthcare, there has been a change in the focus of reimbursement strategies that are affecting the delivery of patient care. This shift from a fee-for-service towards a value-based system creates a challenge that has shifted many providers’ focus more directly on their revenue. As a result, organizations are forced to take a hard look at the cost of services they are providing patients and then determining if the services and level of care are appropriate for the prescribed patient care.
... to the medical malpractice problem. One way is to have profit companies with expertise in evidence-based medicine to buy or license guidelines from the government. This way the doctors would have immunity from malpractice cases (Avraham, 2011). Rather than public regulators, private regulators would discourage expensive procedures, because of this the doctors would less likely invest in unnecessary procedures that could potentially harm the patients (Avraham, 2011)
With the explosive growth in the 1990s of managed care that were sold by health insurance companies, physicians were suddenly renamed “providers.” That began the deprofessionalization of medicine, and within a short time patient became “consumers” (The New York Times). The shifts in American medicine are clearly leading to physicians' losing power, which results in deprofessionalization. The subsequent deprofessionalization of physicians should not surprise Americans. Although many people spend time and effort evaluating the present state of medicine, they fail to integrate an important piece of information: physicians and sociologists predicted all of today's events more than ten years ago (Hensel, 1988).
reimbursement determinations. As a result, the camaraderie among physicians has developed into a more aggressive approach to impede competition (Shi & Singh, 2012). Little information is shared with patients in regards to procedures or disease control. The subjects are forced to rely on the internet for enlightenment on the scope of their illnesses (Shi & Singh, 2012). Furthermore, the U.S. health care system fails to provide adequate knowledge on billing strategies for operations and other medical practices. The cost in a free system is based on supply and demand and is known in advance of hospital admission (Shi & Singh, 2012). The need for new technology is another characteristic that is of interest when considering the health care system. Technology is often v...
Rich Dad, Poor Dad is a non-fiction book written by Robert Kiyosaki. Kiyosaki takes us into his life to describe to us the difference between two separate households and how they manage money. When you first open up the book, you are immediately shown the confliction Robert has between choosing whose advice to follow. His biological father is known as his poor dad who is highly educated but doesn’t make the right choices when it comes to money. His rich dad isn’t his father but is a childhood friend’s father who is also trying to teach Robert how to manage money. Rich dad has very little education background but the way he deals with money is what made him successful. Robert’s poor dad views education as the main principle to success. As long as you do well in school, you will have a good steady job thought poor dad. Poor dad always stated “I’m not interested in money”, and “money doesn’t matter.” Rich dad on the other hand knew how to make money work for him not the other way around. He felt that in order to succeed and make a lot of money, you need to work for yourself and not others. Robert learned many lessons from both dads and he feels he is very fortunate to have had two father figures to teach him and give him examples on how to become rich and successful.