Reimbursement and Pay for Performance Research Paper

Excerpt from Research Paper :

Reimbursement and Pay-For-Performance


This entails day-to-day programs designed to offer monetary incentives to health care providers and physicians to meet efficiency, quality and other defined targets. Pay-for-performance entails Agency for health care and quality, which defined as improved strategies in health care delivery, which majorly relies on the use of purchase power or the market power (Heywood, 2002). They referred as proper a financial incentive that heavily rewards service providers for their great achievements over a range of client objectives, such as, data submissions, payer's measure, safety of the patient, quality improvement, and the efficiency in service delivery (Brown, 2002).

Larger number of employees, proper health plans, and the purchase of health care services, which includes Medicaid and Medicare concurrently tries to seek conclusive evidence on what works best or poor in the Agency for health care and research quality resources on pay for performance (Heywood, 2002). However, the pay for performance programs comprises of several sponsors, who include, the health insurance plans, the employers, a variety of coalitions, health care providers and government agencies.

Earlier lesson show that pay for performance programs engage healthcare providers with lots of competitions thus managing to change their behavior (Brown, 2002). They help in sending timely and actionable patient follow up results to service providers and encouraging providers to continuously participate in quality improvement practices across the healthcare system thus reducing unnecessary discrepancy practices. The pay for performance programs shown huge improvements in quality clinical measures, and the positive success in encouraging service providers to adopt proper clinical decision systems worldwide (Heywood, 2002).

Proper implementation of the pay for performance programs resulted to day-to-day improvements in the provision of healthcare services to its clients, thus encouraging the rebirth of the health care system. This achieved through the introduction of massive health insurance plans a cross the world to help in improving the health care system.

How the pay for performance approach affects reimbursement

Reimbursement is the act of repaying or compensating someone for a given expense incurred either through employment or in a given account for carrying out another person's or party duty. Reimbursement occurs in various forms such as, mobile expenses, medical expenses, and transport expenses (Byrne, 2011).

Reimbursement in today's health care systems gets resistance from the pay for performance programs introduced across the world in various ways. Health care providers and the physicians work in specific areas thus offering different levels of services to its customers. With the emergence of pay for performance programs into the health care system, reimbursement to the service corrupt governance affects providers in the health care system (Gelband, 2000). This observed when the low-income earners in the health care system reimbursed unlike those with higher income who paid according to their performance. Reimbursed services covers all the healthcare providers in the system without scrutinizing the pay for performance approaches observed or carried out.

Reduction in service provision by health care system basing on pay for performance never observed during the reimbursement process, which leads to higher interests in the process resulting to a decline in revenue collection through the process (Aaron, 2000). Free services offered to the health care service providers such as transportation costs catered for during the reimbursement process thus acting as a waste of resources through the pay for performance programs.

The pay for performance approach method in the health care systems happens to benefit those who earn more in this program through huge calculated reimbursement acts thus suppressing other working colleagues (Gelband, 2000). The minority group in the health care system subjected to less reimbursement acts due to the pay for performance approach established by the health care systems across the world.

How system cost reductions impact the quality and efficiency of health care

System cost reduction implies reforms the simply shifts federal spending to employees, individuals, and states failing to address the major problem, which eventually leads to many people foregoing the necessary or recommended health care services. System cost reduction affects payment rates globally thus every providers and payers payment rates shoots up thus affecting the health care system. The cost incurred should be avoided by privately negotiating rates that automatically fits within a global spending target agreed upon.

System cost reduction affects fee payments for services rendered by physicians and other service providers thus affecting the completely health care system. Various amounts of payments rendered by the health care service providers, therefore possesses as a major challenge in the health care system. Proper methods implemented such as using an alternative fee payments to services rendered by the physicians, and other health care providers in a fixed amount for a bundle of services offered (Aaron, 2000). The payer's acceleration method for alternative payments method established to cater for cost system reduction thus enhancing the health care system.

System cost reduction results to a reduction of the number of employees in a given health care system thus affecting the competence and eminence of health care services. The health care system by trying to reduce the number of health care service providers, significantly affects the quality of services rendered because straining resources available. To increase efficiency in a given health care system, the level or number of service providers should be increased thus promoting quality health care services to its customers.

System cost reduction in a given system entails change of suppliers of a given commodity, which essential in the provision of better health care services. Change of suppliers in a given health care system for achieving a system cost reduction results to poor supplies of commodities, which in turn affects the provision of better health care services.

How pay for performance affects health care providers and their customers

With the introduction of pay for performance approach into the health care system, health care providers and their respective customers experience several challenges, which in turn affect the provision of quality services. Incentives that introduced into the health into the pay for performance programs, which regarded as rewards for health care providers for achieving a specified performance target acts as a boaster thus increasing their morale at work (Byrne, 2011).

Customers or patients eventually be neglected when financial incentives become incorporated into the pay for performance of the service providers. This eventually leads to poor medical services offered to its customers thus leading to decline of the health care system.

Health care providers cost cut down because their achievement becomes heavily rewarded with the introduction of pay for performance programs observed through services such as free medical care, and free transport. With such services catered for, health care providers will try to increase the quality of services they offer to their customers, which in turn acts as an advantage to the customers. The customers receive quality services from the health care service providers knowing very well they will be rewarded abundantly (Heywood, 2002).

Effects pay for performance will have on the future of health care

Pay for performance programs introduced into the health care system possesses both positive and negative impacts into the health care system. Careful constructed incentives when incorporated to the pay for performance programs leads to a greater improvement in the quality of health care provided (Flower, 2012). The increment of incentives into the pay for performance programs to the service providers leads to improvements in quality of health care thus most attention focuses on quality improvement.

With the establishment of pay for performance into the health care system, health care inequalities emerge where by poor outcomes and much lower rates of engaging in certain populations groups drops significantly (Flower, 2012). This would result to communities with the greatest health care needs to receive the poorest health care services from their respective service providers thus leading to a decline in the health care system.

Pay for performance programs helps to reduce racial or ethnic disparities, which escalated ever since the establishment of health care systems across the world. The program will help curb the vice of racial treatment in provision of health care services across the health care systems. This system or program rewards each individual according to the level of performance and not basing on racial or ethnic groups. By curbing the vice of racial or ethnic disparity in delivering of services based on pay for performance, a greater and a well-established health care system established (Mitchell, 2003).

Health care systems improve because the health care service providers enjoy the availability of well-equipped facilities provided by well-wishers or sponsors from across the world. The health care system forced to acquire modern facilities due to the efficiency of the service providers who work hard to reward by the pay for performance programs, which in turn boasts the health care system.

The pay for performance programs introduced into the health care results to poor acquisition of tenders for the supply of medical equipment's for selfish gains. These results to poor services rendered to the customers thus a decline in the health care system delivery of services (Flower, 2012).


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