overview of various forms of physician reimbursement

 overview of various forms of physician reimbursement

The persistent increase in healthcare costs and its probable negative implications to the United States’ economy forced the policymakers and other relevant institutions to rethink the progress of the health care sector. According to analysi8sd made by experts, the unsustainability of healthcare costs was associated with the fueling of the nation’s debt hence a threat to economic performance. As a result, the NCPPR was one of the measures adopted to respond to the challenges associated with the continued rise in the costs of health care services. The decision by the Society of General Internal Medicine (SGIM) to create the National Commission on Physician Payment Reform was aimed at analyzing the implications of physicians’ pay and incentives on patient cared. The paper gives a brief overview of various forms of physician reimbursement and some of the notable recommendations in the report, which reflected on the desire to address physician payment to realize the intended goals.

There are diverse forms of physician reimbursement used in paying medical practitioners in the United States. Fee-for-service is one of the standard reimbursement models used in the payment of such practitioners (Casper et al., 2019). Under this model, there is the unbundling of the services offered, and then they are paid differently. It is a payment model under which the quantity of care plays a critical role in determining payment as opposed to the quality of care, which was the primary factor dictating payment. Even though it is one of the dominant payment models, some individuals critique it as an approach leading to high costs of healthcare services. Besides, the model is critiqued to discourage efficiencies. Value-based payment models are also conventional in the healthcare sector. Under this model, payment approaches such as payment-for-performance and Pay-for-Coordination are used in paring various medical professionals (Song & McMahon, 2015). Similarly, Relative Value Units are utilized in reimbursing physicians. The approach has work, malpractice, and practice expense as the necessary components.

To respond to various challenges associated with the increasing costs of healthcare services, the report pointed out various recommendations to guide operations under the health care system. I agree with the first, fifth, and sixth recommendations are the fittest approaches in responding to the challenge characterizing the American healthcare system. As briefed earlier, the primary purpose of the report was to realize fundamental changes in the healthcare sector and ensure that American citizens acquired the services at an affordable cost. The first recommendation sought to eliminate stand-alone-fee-for-service (Physicianpaymentcommission.org, 2013). According to this recommendation, such payment led to problematic financial incentives and inefficiencies, thus curtailing the realization of the desirable health reforms. The suggestion is perfect since it seeks to minimize the costs of healthcare, which is the principal purpose of formulating the report. The healthcare sector aims to emphasize the prevention of disease rather than treatment as the best approach to enhance citizens’ health. Such payments curtail the realization of such dreams; hence their elimination can ease the attainment of such ultimate goal.

Similarly, the fifth recommendation was excellent, and one of the best considerations in facilitating positive reforms in the health sector. The proposal, which calls for the elimination of higher pay for all the facility-based services which can be easily realized through settings with much lower costs, is an excellent move towards achieving the desired reforms in the health sector. Besides, the recommendation calls for transparency in reimbursing medical practitioners as an excellent move in transforming the health sector (Frist et al., 2013). I agree with the recommendation because of various reasons. First, the proposal calls for equality in the payment of physicians regardless of setting or specialty. Such uniformity is a critical consideration in ensuring that all physicians feel motivated. The motivation is fundamental in influencing them to offer quality services to patients visiting their facilities. Similarly, the sixth recommendation is faultless. The proposal calls for the consideration of the component of quality while determining reimbursement. The provision of quality health services is one of the necessary measures towards enhancing the health of American citizens. According to the recommendation, the incorporation of quality metrics is one of the moves that can mitigate the continued provision of poor services as practitioners seek to maximize income. Such an argument is faultless. I found the recommendation excellent because it emphasizes the need to ensure there is the provision of quality services, which is vital in ensuring that American citizens remain healthy. Furthermore, the recommendation emphasizes the aspect of outcome-based performance, which is a critical consideration in ensuring that citizens access standard health services.

In summary, the paper reflects on the recommendations under the RNCPPR and some of the common forms of physician reimbursement. Fee-for-services is a common approach used in reimbursing physicians. The model calls for the reimbursement of physicians depending on the services offered to patients. The value-based payment models and relative value units are other standard models utilized in physician reimbursement. Another consideration under the paper relates to the recommendations in the report. The report had twelve recommendations that aimed at transforming the healthcare sector I found the first, fifth, and sixth recommendations as the best in the report since they aim at ensuring that medical practitioners offer quality health services. Even though all the proposal seeks to transform the sector, the three provide an excellent platform and approach that can help in improving the quality of healthcare services and reducing costs for citizens.

References

Casper, D. S., Schroeder, G. D., Zmistowski, B., Rihn, J. A., Anderson, D. G., Hilibrand, A. S., … & Kepler, C. K. (2019). Medicaid reimbursement for standard orthopedic procedures is not consistent. Orthopedics, 42(2), e193-e196.

Frist, W., Schroeder, S., Bigby, J., Brennan, T. A., Delbanco, S., & Gallagher, T. (2013). Report of the national commission on physician payment reform. Washington, DC: Robert Wood Johnson Foundation.

Physicianpaymentcommission.org. (2013). Report of the National Commission of Physician Payment Reform. Retrieved 1 February 2020, from http://physicianpaymentcommission.org/wp-content/uploads/2013/03/physician_payment_report.pdf

Song, Z., & McMahon, L. F. (2015). Rethinking physician payment.