Healthcare Compliance & Reimbursement:Chapter 10 Assignment
Review Questions
1. Why did pay-for-performance and value-based purchasing systems emerge?
2.What is attribution, and by what other terms is this process known?
3.List three other countries that are investigating or have implemented pay-for-performance systems for their healthcare delivery systems.
4. What three components do pay-for-performance and value-based purchasing systems typically link?
5. The Centers for Medicare and Medicaid Services has attempted to put the brakes on the trend to pay-for-performance and value-based purchasing systems because its experts believe the linkage of quality and rewards jeopardizes the care of patients. True or False?
Application :
Scenario: A family physician sees approximately 29 patients per day (Gottschalk and Flocke 2005, 490-491). Of these 29 patients per day, 5 are Medicaid patients and 3 of those Medicaid patients are well-baby visits. The state Medicaid plan has implemented P4P and is utilizing the HEDIS® measures. One of the measures is that babies have 6 well-baby office visits by 15 months of age. At the current time, the family physician receives a $100 bonus per baby with 6 or more well-baby visits by 15 months. The Medicaid program has proposed two methods of restructuring the incentives:
$25 bonus for each set of 3 well-baby visits to the family physician and a $15 gift certificate for each set of 2 well-baby visits to the parents
$100 bonus per baby receiving 5th well-baby visit and polio, hepatitis B, and Haemophilus influenzae type b (Hib) vaccines by 13 months and a second $100 bonus for the 6th well-baby visit by 15 months and relevant vaccines
Of the three methods, current and two proposed, which method would result in the highest financial reward for the family physician? Which method would result in the lowest financial reward for the family physician?
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