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Healthcare reimbursement quizlet
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This article takes a look at ten physician compensation models including the incentive structure and how they affect quality of care. The article compares these different models from three perspectives: a brief description, the underlying incentive structure, and the usage-related risks. The author states that a compensation model may comprise of multiple models given that healthcare organization may have more than one contract with its payers. While the author provided a complete comparison of each model, he did not state the preferred model for the healthcare industry. He concludes that most physicians and other health care leaders lack control of reimbursement for services from the federal and state government as well as private commercial
Each model presents different types of earning incentives for physicians to provide cost effective care which improves clinical outcome.
This group is more focused on satisfaction, access and quality of care. Providers, or practitioners, are also key stakeholders within an organization. The term provider can encompasses not only physicians and surgeons, but also nurses, physical and occupational therapists, technicians, and other members of a clinical staff. Providers fall into two categories, primary, which includes hospitals and health departments and secondary, which includes educational institutions and pharmaceutical companies. Providers are focused on the best treatments for patients and are involved in delivering health services and products. The final element of the MCQ model is the employer who by far is the largest paying and purchasing stakeholder of an organization. The employers focus is primarily on their return on investment within an organization. Cost and quality is a focus for employers when choosing health benefits but are mindful that access is just as important. Within the Patient Healthcare model, MCQ explains the interactions between the four elements of employer, patient, provider and payer while the Iron Triangle focuses on the factors of cost, quality, and access. The Patient Healthcare model charges healthcare leaders with the task of balancing satisfaction with the stakeholder (employer, patient, provider, and payer) in relation to cost, quality and access. This may be very difficult since stakeholders may have competing priorities. Changes and variations made in how healthcare organizations operate may have profound effects on how stakeholders perceive the quality, access and cost. For instance, a patient may consider cost to be a top priority when seeking healthcare and at the same time the healthcare organization may consider raising costs and therefore devaluing access and quality. Patients who begin to incur high out-of-pocket costs may begin to perceive a financial
Managed care reimbursement models have contributed to risk avoidance by negotiating discounts, discouraging use, and denying payments for charges that appear to be false. Health care reform has increased awareness to the quality of care providers give, thus shifting the responsibility onto the provider to provide quality care or else be forced to receive reduced reimbursements (Buff & Terrell,
In recent times, healthcare organization across the nation are facing unprecedented challenges as they strive to improve the overall quality of care provided to their patient’s population, while improving their organization’s financial performance. Furthermore, uncertainty of new reimbursement models, diminishing reimbursement, and complicated compliance regulations are playing the role of a catalyst for streamlining the Chargemaster process in majority of healthcare organizations.
As our health care system continues to evolve and become more focused on a preventive and coordinated approach to patient care, we too must progress and create programs that follow such principles. The Patient-Centered Medical Home (PCMH) model follows similar ideologies and recently has gained increasing support. The patient’s primary care physician, who will provide preventive and continuing care for the patient, directs this medical model. The PCMH model of care is comprised of a health care team working together to serve their patient and provide quality care.1 The model works to empower the patient by promoting communication with not only the physician but with the nursing staff, specialists, and other health care providers. Every patient
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...
Doctor Money’s research with David Reimer can be classified as research motivated by exploration. At the time sex change was not well known or accepted in the culture of the Canadian society. It was not very often heard of a male or female changing their gender and going through sex change operation. Upon Doctor Money hearing from the twin’s parents, he found it as an excellent case to explore his theory on sex change. The exploratory method uses occurs when a researcher examines a new study, which in this case would be sex change. Exploratory theories are a source of grounded theory when a researcher is trying to break into a new field. As explained in our textbook exploratory studies tend to have three purposes. They are to satisfy
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 compensation committee has a difficult task upon its shoulders. It must construct pay programs that attract and retain the best talent to address the individual organization’s needs. It must design a strategy that generates superior returns for investors, appropriately measure managerial performance, and institute a pay practice which is fair to both employees and shareholders and which really drives business results (Mercer p.4). There is abundant theory and research on the strategies thought to accomplish these goals, and the emerging trends in executive compensation seem to be highly successful.
2. The twin problems of the health care industry as viewed by society are cost and access. First of all, the cost of getting health care is very high and it is getting higher each day. This has been mostly caused by the combination of high cost and an increase in quantity of services provided to the communities. The other problem involves access to health care. American enjoy limited or no access to health care. Many efforts have been done to reform this, but still but still many people are left without access to the care. These two problems are related due to the fact that if the health care industry gets to high off course people no longer will be able to have any access to it. The higher prices are, the lower access people have to it.
Fee-For-Service (FFS) is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care. Similarly, when patients are shielded from paying cost sharing by health insurance coverage, they are incentivized to welcome any medical service that might do some good. FFS is the dominant physician payment method in the United States, it raises costs, discourages the efficiencies of integrated care, and a variety of reform efforts have been attempted, recommended, or initiated to reduce its influence.
Compensation for today 's average worker has always been a highly sensitive topic for any employer. Determining fair compensation can be a overbearing task as there are many contributing factors that make up the general pay scale. When determining pay a company must always consider the hourly amount, the benefits that may be offered, any incentive that could potentially be incurred and ensuring that their employee have an established work life balance. For an employer to be successful in determining compensation for their associate they must remain grounded around 1 key principle. An employees compensation is determined by expertise, education and the daily duties performed by the employee.
From this interview and assignment I discovered that individuals that compensation specialist requires a great deal of experience, knowledge and skill. The compensation specialist that I met with had over 15 years of experience, as well as her Master’s degree in business administration. In addition, there seems to be a need for detailed understanding of the legal ramifications in respect to compensation based upon department of labor standards, as well as a great deal of knowledge of the average pay that is received by individuals within a variety of different occupations within healthcare
Employee compensation and reward systems have undergone a couple of paradigm shifts since inception. Reward systems were traditionally compensation based and focused on the individual or the position (Beam 1995). After a recession in the early 1980's, employers turned to performance based models in an attempt to save money while still rewarding top performers (Applebaum & Shapiro, 1992). Today, the most successful organizations are using a total reward model, a hybrid of the performance based model combined with strategic human resource management planning to create reward systems that both benefit the employee and help organizations realize their operational goals (Chen & Hsieh, 2006).