Reimbursement and Pay for Performance
Vera Younger
HCS/531
June 29, 2015
Sarah Dunn

Reimbursement and Most of the gadgets came paired with smartphone apps designed to extract meaningful information from an individual’s raw data, taking the guesswork out of everyday living. The pitch was that a person needing guidance on daily lifestyle decisions such as what to eat, when to sleep, and how much to exercise could simply consult the data dashboard.
The definition of Pay for Performance can be summarized as the following two statements; the impetus behind P4P is to improve the quality of patient care by aligning financial incentives with cost effective quality improvement. The goal of P4P is to reimburse providers based on performance of quality and efficiency measures that result in improved outcomes vs. current reimbursement methods that reward patient care volume rather than improved care (Elements of Pay-For-Performance in Health Care, 2012). Pay-for-performance is a value-based purchasing strategy with the initiative to link reimbursement to quality and efficiency as an incentive to improve health care, as well as reduce costs (Shi & Singh, 2012). The goal of the pay-for-performance model is to increase the quality of health care, while reducing costs by implementing programs that focus on preventative care, like vaccinations and annual exams. With improved quality care, people should be able to live longer healthier lives. The pay-for-performance (P4P) is designed to address health care underuse (e.g. inadequate preventative care) and overuse (e.g. unnecessary medical tests) because it pays for value, efficient, and effective care (Reimbursement and Pay for Performance, 2013).
There are three critical elements to make this program succeed: attribution, measurements and evaluation, which all lead to rewards. Attribution can be explained as assigning the accurate patient, to the accurate physician and to the accurate practice. This process identifies who is responsible for the appropriate care of the patient.
The primary care physician can be assigned by the insurance plan or by the patient. If an physician is not assigned or chosen the primary care physician should be attributed as followed;
1) The physician or practice that sees the patient more than two times in a year. If more than one physician sees the patient twice then attribution should be to the physician that orders the most preventive medicine screening tests.
2) A sub-specialty physician can be the primary physician for a patient when the patient’s primary diagnosis is in that field (i.e., chronic renal failure to the nephrologist) (Elements of Pay-For-Performance in Health Care, 2012).
Measurements are calculated by using technology. All physicians and medical facilities should use the same methods of data collection to be in compliance or to compare data more efficiently.
Evaluation should be completed annually. Within the first year physicians should be compensated for participation. Practices with poor or below the national, state or local average should be compensated on an improvement rate. Practices above average should be compensated on their scores.
Pay for Performance reimbursement affects the approach in a number of methods. There are four strategies that express the quality of health care and this would include, government regulations, marketplace competition, continuous quality improvement and payment incentives. Reimbursement is affected by the P4P approach in the fact that the physician has an incentive to improve quality care to earn more bonuses, therefore increasing their annual income by 10% (Reimbursement and Pay for Performance, 2013).
Reimbursement has affected the pay for performance positively by assisting physicians and facilities to become more transparent. Using technology as in social media will allow consumers to review provider ratings. Potentially the higher the rating of service, will result in a higher