Payment Mode Analysis

Payment mode analysis

Author name

Affiliations

Today healthcare providers are going for new reimbursement models in order to lower their costs and enhance care.

Some payment models are:

Payment Mode Name

Summary

Strengths

Weaknesses

Fee for Service

Government agencies and insurance companies pay physicians and healthcare providers

Payments are unbundled in this method ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"PHvWHpni","properties":{"formattedCitation":"(Ikegami, 2015)","plainCitation":"(Ikegami, 2015)","noteIndex":0},"citationItems":[{"id":2302,"uris":["http://zotero.org/users/local/KZl8ZL3A/items/KMMRVFCR"],"uri":["http://zotero.org/users/local/KZl8ZL3A/items/KMMRVFCR"],"itemData":{"id":2302,"type":"article-journal","title":"Fee-for-service payment–an evil practice that must be stamped out?","container-title":"International journal of health policy and management","page":"57","volume":"4","issue":"2","author":[{"family":"Ikegami","given":"Naoki"}],"issued":{"date-parts":[["2015"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Ikegami, 2015).

Freedom of choice

Patients receive highly valued service

No delay

Expensive

Paperwork

No preventive benefits

Restricted to personal visits

Pay for Performance

Physicians and healthcare providers

are paid based on productivity

​

Worker motivation

Encourages efficiency of care

Subjective performance measurement

Can result in low quality

Patient-Centered Medical Homes

This model provides safe, high-quality and accessible patient-centered care by coordinating care across all segments of the healthcare structure ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"gdfswQll","properties":{"formattedCitation":"(Budgen & Cantiello, 2017)","plainCitation":"(Budgen & Cantiello, 2017)","noteIndex":0},"citationItems":[{"id":2304,"uris":["http://zotero.org/users/local/KZl8ZL3A/items/ZLFWHAJK"],"uri":["http://zotero.org/users/local/KZl8ZL3A/items/ZLFWHAJK"],"itemData":{"id":2304,"type":"article-journal","title":"Advantages and Disadvantages of the Patient-Centered Medical Home: A Critical Analysis and Lessons Learned","container-title":"The health care manager","page":"357-363","volume":"36","issue":"4","author":[{"family":"Budgen","given":"Jacqueline"},{"family":"Cantiello","given":"John"}],"issued":{"date-parts":[["2017"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Budgen & Cantiello, 2017).

Most convenient for patients

Reduce healthcare costs

Enhance the delivery of preventative services

Limited choice of providers

Multiple steps required to receive care

Accountable Care Organizations

Groups of doctors, hospitals, and other health care providers who come together voluntarily to provide coordinated high-quality care

Better care for patients

Physician-driven treatment.

Challenge of data security of patients

Increased administrative costs

Bundled Payments

Provide a fixed amount of payment for all services provided for a single episode of care ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"r3Wx2SOZ","properties":{"formattedCitation":"(Shih, Chen, & Nallamothu, 2015)","plainCitation":"(Shih, Chen, & Nallamothu, 2015)","noteIndex":0},"citationItems":[{"id":2303,"uris":["http://zotero.org/users/local/KZl8ZL3A/items/KR3EI9DY"],"uri":["http://zotero.org/users/local/KZl8ZL3A/items/KR3EI9DY"],"itemData":{"id":2303,"type":"article-journal","title":"Will bundled payments change health care? Examining the evidence thus far in cardiovascular care","container-title":"Circulation","page":"2151-2158","volume":"131","issue":"24","author":[{"family":"Shih","given":"Terry"},{"family":"Chen","given":"Lena M."},{"family":"Nallamothu","given":"Brahmajee K."}],"issued":{"date-parts":[["2015"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Shih, Chen, & Nallamothu, 2015).

Increased coordination among multiple caregivers

Flexibility in place and timing

Coordination across multiple providers

Payment distribution difficulties

Unreliable data refutes benefits

Inspire disparaging competition for patients with cost-effective bundles.

Global Budgets

A fixed payment amount is allotted to a health care provider for covering operating expenses for a specific period

Budget is predictable

No incentive to improve quality

Payment Mode Activity

A 28-year-old with poorly controlled diabetes

Patient-Centered Medical Homes as it will reduce healthcare costs and a specialist will be available at an affordable cost.

An elderly individual with multiple chronic conditions

The preferred payment model will be bundled payments as it will offer flexibility in place and timing and there is also increased coordination among multiple caregivers to treat the ailment.

A pediatric neurosurgeon

Pay for Performance is preferred payment model as physicians and healthcare providers are paid based on productivity.

A registered nurse

Fee for Service is the preferred payment model in this scenario as payments are unbundled in this method.

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Budgen, J., & Cantiello, J. (2017). Advantages and Disadvantages of the Patient-Centered Medical Home: A Critical Analysis and Lessons Learned. The Health Care Manager, 36(4), 357–363.

Ikegami, N. (2015). Fee-for-service payment–an evil practice that must be stamped out? International Journal of Health Policy and Management, 4(2), 57.

Shih, T., Chen, L. M., & Nallamothu, B. K. (2015). Will bundled payments change health care? Examining the evidence thus far in cardiovascular care. Circulation, 131(24), 2151–2158.