Pay for Performance

Better Essays
Reimbursement and Pay-for-Performance
HCS/531
March 25, 2013

Reimbursement and Pay-for-Performance With health care reform taking full effect, various changes are emerging with regard to health care provider reimbursements. Third-party and government payers are rapidly moving toward pay-for-performance approaches that emphasize the quality rather than the quantity of health care services. Pay-for-performance initiatives have the capability of significantly impacting reimbursements based on whether or not and to what extent certain performance outcomes are met. At the same time, health care providers and consumers are both positively and negatively affected by pay-for-performance programs. While the future of pay-for-performance programs is unknown, it can be assumed that health care providers will likely carry increased pressures with regard to outcome responsibilities. With the continual addition of regulations set forth by the Centers for Medicare and Medicaid Services (CMS), demands to consistently provide high-quality care will increase.
Pay-for-Performance
Pay-for-performance is a payment model that rewards physicians, hospitals, medical groups, and other healthcare providers with financial incentives based on performance on select measures (Epstein, 2012). These performance measures can cover various aspects of health care delivery including: clinical quality and safety outcomes, efficiency, health care access and availability of care, patient experience and satisfaction, cost of care, administrative compliance, and the adoption of health information technology (Richmond, 2013). By providing direct incentives, physicians and other health care professionals can engage in practices that will hopefully increase the quality of care to patients, while controlling skyrocketing health care costs. While pay-for-performance is not an entirely new concept, the renewed interest can be attributed to the Affordable Care Act and initiatives within the Act



References: Chen, J., Kang, N., Taira, D., Hodges, K., & Chun, R. (2010). Pay-for-performance programs show positive mpact on low-performing physicians CMS.gov. (2013). Readmissions reduction program. Retrieved from http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Acute the details. New England Journal of Medicine. 367, 1852-1853. Jauhar, S. (2008). The pitfalls of linking doctors’ pay to performance. The New York Times Santo, T. (2013). How will pay for performance ultimately impact quality of care? MedPage Today.Retrieved from http://www.kevinmd.com/blog/2013/01/pay- (2010). Effect of improved glycemic control on health care costs and utilization. The Journal of the American Medical Association, 285(2), pages 182-189. Ward, T. (2008). A glimpse at the future of pay for performance. Health Leaders. Retrieved from http://www.healthleadersmedia.com/content/LED-213822/ A-

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