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04/15/2019

Reimbursement is the compensation or repaying of money that was spent due to one's behalf. Health care providers are reimbursed for the services and money they grant people. Various reimbursement methods exist among which include:

Fee-for-service, (Whedon, et al, 2017). This mainly is the payment made to health care providers for the service they have offered. In this overtime job done is also included. Fee-for-service also includes the inpatients and outpatients. In the inpatients, the providers negotiate the stop-loss provisions and carve-outs in order to balance the stipulated risk. For outpatients, fee-for-service is made at individual services but has been expanded to the grouping of codes in pre-defined ambulatory payments grouping.

Value-based-reimbursement is another form of reimbursement to health care providers. In this providers are reimbursed due to their efficiency or quality of their service. Several benchmarks are made in order to determine the quality of the service. However, motivations such as incentives are made in order to increase the performances.

Bundled payment also falls in the reimbursement methods of health care providers. In this, the providers are reimbursed at episodes of their care. In this, care coordination is mainly reimbursed. This method motivates the coordination of care and prevents the provision of unnecessary medical services.

Based on these reimbursement methods, value-based-reimbursement will work best for a hospital. As it has been seen, value-based-reimbursement is a payment made due to the quality of service made. This will be advantageous to the hospital since both doctors and nurses will be concerned about improving their quality of work in order to be reimbursed.

Another reason is that patients will receive better services and complains will reduce. This will improve the hospital's performance in general. Patient satisfaction will be met by the hospital due to the quality service offered, (McIntosh, et al, 2017).

Value-based-reimbursement will also reduce errors in the medical service. Since the health care providers will be mainly concerned with providing high-quality services, medical errors will be close to zero. Every provider will be focused on their work.

This reimbursement method will also attract more patients to the hospital. Following the high-quality service among every health care provider in the hospital, patients number will increase and the hospital will enjoy the high rewards.

To add to this, value-based-reimbursement will also promote habits that are healthy. This is mainly because the employees will be focused on displaying quality services and this will be a habit to them. The providers will also display an improved health habit due to the rewards given.

However, this reimbursement method has cons. To begin with, poor data management in the hospital will make it not realize the value-based goals. This is because data is necessary for any organization in order to know the past and plan for future events. Lack of data will make it difficult to meet these value-based plans.

Another disadvantage is that these health care providers are also lacking inconsistent reports on their performance, different measures for their performance and their relationship with the payers having no transparency. This is mainly due to the poor data records and hinders the hospital facility in meeting their value-based goals.

This reimbursement also affects patient trust for the health care provider. Even with the hospital following the value-based model, health care providers may get worried as to whether their patients are seeing positive results. This is mainly due to inconsistent performance reports and lack of transparency with the payers.

To add to this, health care providers handle many patients and have to provide services to them. Improving their performance is actually a huge task that tends to exhaust them. Providers are too busy focusing on patients care than improving their quality of service. Also, the large volumes of patient's data in the hospital make the data reports to be poor. Many patients go to the hospital each day of work. In this, their credentials have to be recorded for every visit. This alone is a huge task to the health providers aside their medical services.

The quality reimbursement method also has an impact on the finances of the hospital. In a positive way, this method reduces costs to the hospital, (Saleh & Shaffer, 2016). This is because, quality services will be offered to patients, medical errors will be close to zero, increase in patient's volume and thus a satisfaction by the hospital's insurers. This will enable the hospital to be competitive in the market and increase its output.

How the costs of rewards in order to increase the health care providers will cost the hospital a lot of funds. The quality services as it has been seen require motivation such as incentives. The hospital will be therefore required to spend in order to earn.

To sum it up, health care providers are usually reimbursed through various methods such as the value-based-reimbursement and the bundled payment. The value-based is advantageous to the hospital by increasing the quality of service and patient's satisfaction. However, lack of data and inconsistent performance reports negatively affect this method.

References

Whedon, J., Tosteson, T. D., Kizhakkeveettil, A., & Kimura, M. N. (2017). Insurance reimbursement for complementary healthcare services. The Journal of Alternative and Complementary Medicine, 23(4), 264-267.

McIntosh, K., Morgan, L. G., & Werner, M. R. (2017). The evidence of the clinical and economic benefits of integrated care is extensive and compelling, but far less clear are concrete answers to the question of how to pay for it. This chapter will review the major reasons why, despite proven benefits, many organizations providing integrated care con-tinue to struggle with sustainable financing models. Integrated Care: A Guide for Effective Implementation, 215.

Saleh, K. J., & Shaffer, W. O. (2016). Understanding value-based reimbursement models and trends in orthopaedic health policy: an introduction to the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Journal of the American Academy of Orthopaedic Surgeons, 24(11), e136-e147.