Question

Investigate the CMS website to determine their current and proposed value-based or pay-for-performance programs. Compare one or more of the programs to the traditional fee-for-service payment method. What are the advantages and disadvantages of each to a physician provider in a small practice?

Answer 1

A value-based program is useful for the health care providers with incentive payment for providing quality care for medicare people. It is valuable because it is paying for providers as per the quality of care they provide for the patient. this value-based payment is paid for performance in health care. CMS spends more than 40% funds for health care it developed with a variety of pay for performance model which impact hospital reimbursement. Fee for service and capitation make different payment models for health care providers. The traditional fee for service model provides a basic fee for the providers for their duty.
Hospital value-based purchasing program(VBP)
This program improves the patient experience through financial support, it encourages the hospital to establish quality care and improve patient satisfaction. CMS funds reduce the medicare payment to increase safety, efficiency, clinical care and cost reduction, patient-centered experience. CMS rewards the highest scores to provide financial awards.
Hospital Readmission Reduction Program(HRRP)
Fee for service reimbursement provides large income for the hospital it is based on a value-based health care program. medicare making penalties for the highest readmission in acute care hospital under HRRP. it includes all acute care if poor performance performed from the hospital they should accept a 3% reduction of medicare payment.
Hospital Acquired condition reduction program(HACRP)
Under ACA, HACRP payment reduction 1% for performance-based risk-adjusted for hospital-acquired conditions like falls, infection, pressure sores. it saves medicare payment of $350 million per year. The penalties for low-quality care providers must be subsidized for high-performance quality care providers.
These programs pay for performance that is a goal-oriented performance program for better health outcomes and productivity for providers.
Medicare practice in small practice provide make advantages in more patient-oriented care, improve quality care, encourage patient-provider relationship, it will be time-consuming, physician co-payment will be low with no deductible.
Disadvantages:
it includes financial risk due to risk reduction coverage, there is low reimbursement and there will be low decision-making power.