3 articles summary
lolo1916
USHealthCareSystemLect05p2topost2.pptMethods for Paying Healthcare Providers
Cont’d
Mon., 2/13/19
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A Key Concept: Who is at Risk?
- Payment systems are increasingly about what are the incentives, and who bears the risk (ie of excess costs)?
- In other words, who is in a position to make money, or lose money, and under what circumstances?
- When thinking about payment systems, always important to ask yourself, what are the incentives, and how do these line up or align (or fail to) with our healthcare system goals?
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Who Bears More Risk, Provider or Payer (Insurance)?
- Under FFS?
- Under Salary?
- Under Capitation?
- Under Hospital per diem?
- Under Hospital DRG?
- Hospital Global Budget?
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What is a Hospital Global Budget?
- Hospital paid a set operating budget annually for all services
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Organizing Payment Systems by Amount of “Aggregation”
| Least Aggregated* | Most Aggregated* | ||||
| By the Procedure | By the day | By Episode of illness | By the patient | By time (within a given time period) | |
| Physician | Fee for Service | - | “Surgeon or “Ob” fee | Capitation | Salary |
| Hospital | Fee for Service | Per diem | DRG | Capitation | Global budget |
| *As a general rule, the more aggregated, the more risk is shifted from the payer to the healthcare provider |
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Capitation: Two-tiered or three-tiered?
We will cover this later
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Capitation: Two-tiered or three-tiered?
We will cover this later
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How Do We Get to
Value-Based Payment?
- Old school: paying more, for merely doing more (whether or not that care was appropriate to the patient’s needs
- Next came: attempts at payment systems that would contain costs, such as capitation – incentivized to do less (whether or not that was appropriate to the patient’s needs
- Current/Future Challenge: How do we incentivize the best quality care AND control costs?
Have a general idea of this progression and this concept, but we will go into more detail later
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