The Emerging Issues in Healthcare Finance Essay Example for Free

The Emerging Issues in Health occupy Finance EssayA few decades back, health care financiers believed that managed care with capitation was the best policy beam that would help control the ever-increasing health care costs. Instead of focusing on healthcare woodland, the administrators focused on the cost per month or per member and the provider organizations which competed for the market share. However, this has changed in the new century as new payment tools puddle emerged due to innovations in the healthcare marketplace. Currently, healthcare is considered in terms of none and efficiency as far as purchase and delivery of healthcare are concerned. Capturing these key features of the genuine healthcare provision, the main objectives of ensuring quality and efficiency has led to the new concept dubbed pay-for- carrying into action. In several(prenominal) other literatures, P4P is know as value- d comfortablyingd purchasing. P4P is a healthcare payment dodge that abide bys physicians, hospitals and conglomerate healthcare providers for their efficiency in healthcare provision. Efficiency in this case is defined in terms of higher quality of healthcare at a relatively low cost (Wu, Nishimi, Kizer, 2005). However, defining quality can be very demanding and challenging to most players in healthcare provision and financing.And as non-homogeneous players in healthcare patients, providers and financiers, render more direct and timely measures for quality and value, the judicature has quickly moved in to help sort out the root wordards. Through the CMS, the United States federal government has been able to come up with quality indicators (QIs), which are endlessly being developed and refined (Rosenthal Richard, 2006). These measures for quality and value are currently addressable in various Web-based portals which the government go fors will increase consumer awareness.Patients are encouraged to compare facilities used by healthcare provide rs with those available in the Quality Indicator Web portals. Moreover, services and treatment by providers can also be evaluated against those available in the web showing standard quality measures. As the oversight body, the CMS as mandated by the federal government has established a provider quality coverage constitution for healthcare. Empowered by the 2006 Tax Relief and Health Care Act, the CMS has put in place the provider quality reporting initiative which rewards physicians and other providers who successfully report their set of quality measures.As a reward the government may recommend bonus payment which is subject to a cap equaling 1. 5 percent of the make out amount of Medicare costs within the six months period of reporting (Wu, Nishimi, Kizer, 2005).. The public and private payers have welcomed the value-based murder as an answer to soaring healthcare costs and also a means of ensure quality service to patients. By 2005, well-nigh 75 percent of all United States companies had connected at least(prenominal) some of their employees pay to work performance and also in healthcare. Currently, over 100 cowcatcher lamp programs undertaken by private and public payers are underway.The current healthcare payment system may reward less-safe services because most insurance companies refuse to compensate for new services and practices intended to reduce errors. Again, the system may also encourage poor workmanship, as hospitals and physicians are allowed to charge additional services compulsory when a patient is infected or injured in the hospital. Pay-for-performance however, tries to avert such loses and has received a lot of support from both public and private payers. American insurance companies hope to save a lot from this program (Rosenthal Richard, 2006)..The healthcare financiers would not scarce be allowed to pay for quality services by physicians and hospitals but would not be required pay for additional services for unintended conseq uences of treatment and care like injury in hospital, negligence during surgery and many others as defined by subject Quality Forum (Leape Berwick, 2005). The current payers like the Center for Medicare and Medicaid Services and Leapfrog Group have learnt from the pilot programs that pay-for-performance greatly affects the outcome and quality of any work and increases performance.These companies are very much optimistic that they would not only reduce cost of healthcare but also ensure that their members receive the best healthcare services. This initiative is expected to attract more private insurance companies to invest in healthcare with hope of increasing the profits and capital base. Many insurance companies may be to offer more wide healthcare coverage to various people as they have would a large capital base due to reduced healthcare costs and therefore a lot to re-invest (Wu, Nishimi, Kizer, 2005).The primary goal of pay-for-performance harmonize to policymakers is to in crease quality in healthcare while at the same time reduced fiscal burden of care (Dudley, 2005). These positives are all pointing to the patients and insurance companies all agree that pay-for-performance would benefit the patients. However, as physicians argue, the P4P system may not be in the best interest of the patient. Insurance companies and other healthcare financiers would be the greatest winners if the pay-for-performance is fully implemented.With the CMS initiative that calls for elimination of payments for negative effects of any medical practices that lead to injuries, other illnesses or even death, other insurance companies that are also willing to undertake such initiative, stand to gain a lot from the P4P system. Considering that doctors may not be perfect all the times and some patients are known to develop new infections even when the best known practices are applied, the healthcare payers would be positively affected by this new payment system (Grossbart, 2006). L essons from the ResearchDespite the good intentions of the value-based performance program, the government still faces one of the biggest challenges in its implementation. Implementation of P4P faces challenges of having everyone agree on the quality standards. The quality measures as defined earlier are objective indicators used to evaluate whether physicians are providing high quality healthcare. For example, a doctor may be required to test the A1C levels in diabetic patients four times p.a. as a quality standard measure. In a pay-for-performance system, physicians who reach this threshold would be salaried appropriately.However, many health providers challenge such indicators by arguing that medical practice is not only an art but also a science and therefore setting up checklists as well as treatment algorithms would be a great disservice to the patients. Again, it is quite common to hear about physicians disagreeing with one another on the appropriate course of medication and treatment that should be adopted by the patients with similar diagnosis and the same medical histories. Therefore if the pay-for-performance system is to be successfully implemented, such disagreements would have to be ironed out first (Grossbart, 2006).It would be quite hard to say the specific impacts of the P4P system in the future as it is still undergoing pilot implementation. Nevertheless, because pay-for-performance is basically focusing on how doctors, hospitals and other various healthcare providers are compensated for their work, an individual patient may not be affected greatly in terms of costs. In the long run if the pay-for-performance is fully and successfully implemented, the greatest beneficiary would be the patient who would receive healthcare at a reduced cost. However, whether the quality of health care would break quality or not is matter still debated.