Cost Patients: Pay-For-Performance Analysis

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Patients: Patients are the largest population interested in the change from fee-for-service to a pay-for-performance system. On a fee-for-service system physicians are paid based on how many and what services they provide (Five, 2011). This FFS system stands largely on the amount of services provided and the number of patients requiring services. If quantity is favored over quality, physicians and facilities are less likely to provide quality care or preventative measures when they’re paid more for reoccurring services, longer hospital stays and more rehabilitation time (Difference, 2013). Subsequently, this costs patients more money, longer stays, more physician visits, and further discomfort. Alternatively, with a pay-for-performance

Again, like physicians, on a fee-for-service system, hospitals and facilities make more of a profit with the number of patients seen and services given. Currently, the payment amount is typically discussed between insurers, providers and other payers, based on defined or administered rates using a formula or funding levels and controlled by guidelines and rules defining what can be billed (Five, 2011). However, with a pay-for-performance system, physicians will be held accountable for the care provided. As explained by Health Policy Briefs, Medicare has already started refusing payment to physicians and medical facilities if patients have acquired a preventable illness or condition during their hospital stay. This furthers the push to provide quality care and prevent hospital or facility acquired illnesses, since it now results in a financial deficit when a patient receives poor quality

At some point in everyone’s life they or a family member will have to visit a physician regardless of whether it’s for a sinus infection, a necessary surgery, if they’re insured or not. Everyone will at some point need medical attention, thus utilizing the money taken out of the publics’ paycheck being put towards healthcare spending. According to Fleming, “By 2020, healthcare spending is projected to be 19.8 percent of GDP, nearly one-fifth of economic output, increasing from 17.6 percent in 2010.” Since, Medicaid and Medicare are funded by Federal and State taxes (Medicare, 2015) with a fee-for-service system; the public will continue to pay for services provided. However, with a pay-for-performance system, providers will be required to make changes within their area of care to ensure that quality is administered and at a lower cost (Better Care, 2015). This means hospitals and facilities will pay for a patients stay if they receive less than quality care, as well as altering how physicians treat their patients. The pay for performance model guarantees the general public will be paying less for healthcare overall, receiving better care the first time they see a physician and will be given quality