Question

• Compare and contrast the major differences between fee-for-services reimbursement (i.e. traditional commercial insurance plans) and the proposed pay-for-performance (P4P) / value-based purchasing (VBP) method proposed and adopted by the Affordable Care Act (ACA). Review government reimbursement methods for Medicare and Medicaid beneficiaries to help identify major areas of change proposed by the ACA.

Answer 1

FREE FOR SERVICE

• In this model of service delivery,physician charges separately for each of the services provided to any patient.Needless to say that physicians prefer this type of model since they are able to maximize their revenues by providing a host of services.However,quality care has overall suffered in this model since physician are not concerned about this model.They are just focusing on providing as many services as they can in order to receive more payments.
• PAY FOR PERFORMANCE In this service payment method payments to the physician are linked with the quality of the health care he/she providing to the patients.It introduces quality and efficiency incentives and works on the model of coordinated care.