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 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
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