Reimbursement and Pay-for-Performance in Healthcare

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Pay-for-performance (P4P) is the compensation representation that compensates healthcare contributors for accomplishing pre-authorized objectives for the delivery of quality health care assistance by economic incentives. P4P is increasingly put into practice in the healthcare structure to support quality enhancements in healthcare systems. Thus, pay-for-performance can be seen as a means of attaching financial incentives to the main objectives of clinical care. However, reimbursement is a managed care payment by a third party to a beneficiary, hospital or other health care providers for services rendered to an insured or beneficiary. This paper discusses how reimbursement can be affected by the pay-for-performance approach and how system cost reductions impact the quality and efficiency of healthcare. In addition, it also addresses how pay-for-performance affects different healthcare providers and their customers. Finally, there will also be a discussion on the effects pay-for-performance will have on the future of healthcare. Discussion How Reimbursement Is Affected By Pay-For-Performance Approach 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... ... middle of paper ... ...correctly with varied crowds of patients to reduce incentives to keep away from most patients is quite challenging. Finally, the effects pay-for-performance will have on the future of the health care depends on incentives with "teaching to the test" to guarantee that the affirmative objectives are not attained at an enormous price. References Kongstvedt, P. (2013). Essentials of managed health care. Burlington, MA: Jones and Bartlett Learning. Langenbrunner, J., Cashin, C. & Dougherty, S. (2009). Designing and implementing health care provider payment systems how-to manuals. Washington, D.C: World Bank. Papanicolas, I. & Smith, P. (2013). Health system performance comparison an agenda for policy, information and research. Maidenhead: Open University Press. Walshe, K. & Smith, J. (2006). Healthcare management. Maidenhead: Open University Press.

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