Reimbursement and Pay-for-Performance

Reimbursement and Pay-for-Performance

Tiffany Langham

HCS/531

March 25, 2013

Mary Helen Mays

Reimbursement and Pay-for-Performance

Health care quality and efficiency is a major issue in the United States and worldwide. There are a number of government and private organization initiatives rewarding providers for high performance. This paper will define pay-for-performance, and discuss aspects of pay-for-performance regarding reimbursement, health care providers and their customers, quality and efficiency, and the future of health care.

Definition and Reimbursement

Health care quality has been an area of contention for centuries, as Americans consistently receive inconsistent delivery of health care services. The Institute of Medicine's 1999 report titled To Err is Human: Building a Safer Health System concludes tens of thousands of Americans die each year from preventable hospital medical errors, costing hospitals billions of dollars. Another report by the Institute of Medicine titled Crossing the Quality Chasm: A New Health System for the 21st Century concludes in 2001 that the United States health care delivery system's poor design is inadequate to provide Americans high-quality care. This report outlines strategies for providers, policymakers, regulators, and others to reinvent the health care delivery system for improving health care quality (Institute of Medicine, 2013). These reports along with earlier period initiatives have led to developing pay-for-performance initiatives. The Centers for Medicare and Medicaid (CMS) has the responsibility to ensure the delivery of high-quality care to beneficiaries while controlling costs. In attempt to improve quality of care and decrease the cost of health care, CMS implemented pay-for-performance initiatives. Other organizations, such as health insurance companies, providers, and quality organizations have implemented also pay-for-performance programs.

According to the Agency for Healthcare Research and...