There a plenty of reimbursement models. Not all reimbursement models fit each health care situation or health care setting. Sometimes reimbursement arrangements or models with providers include some combination of different repayment methods. There are key differences in each reimbursement model. Each reimbursement model has types of care that are parallel or work together.
According to Kongstvedt (2009), “At a simplistic level there are two basic ways to compensate open panel physicians for services” (p. 95). Fee-for-service payment is reimbursement for specific, individual services provided to a patient. As each specific service is being provided it is billed and paid for. Research shows that the following types of care as more appropriate …show more content…
Kongstvedt (2007) states, “the pay for coordination model involves payment for identified care coordination services, usually to certain types of providers” (p. 99). Primary care management and care coordination for patients with long-lasting conditions, and care organization for healthy mothers who are at risk for chronic illness that stem from child birth are some situations that best fit the pay for coordination reimbursement model. Defined by Kongstvedt (2007) , “Pay for performance reimbursement model can be defined as a payment or financial incentive associated with achieving defined and measurable goals related to care processes and outcomes, patient experience, resource use, and other factors.” (p. 104). Pay for performance are services for which metrics already exist including management of some chronic conditions and certain surgeries. An example of when the pay for performance reimbursement model is the best match is programs that that reward improvement in hospitals that decrease the rate of readmissions. Episode payments are single payments for a group of services related to a treatment or condition that may involve multiple providers in multiple settings. These are some types of care that can be best fit for episode or bundled payments kidney transplants, maternity care, open heart surgery, some ambulatory diagnostics or therapeutic
According to Kongstvedt (2009), “At a simplistic level there are two basic ways to compensate open panel physicians for services” (p. 95). Fee-for-service payment is reimbursement for specific, individual services provided to a patient. As each specific service is being provided it is billed and paid for. Research shows that the following types of care as more appropriate …show more content…
Kongstvedt (2007) states, “the pay for coordination model involves payment for identified care coordination services, usually to certain types of providers” (p. 99). Primary care management and care coordination for patients with long-lasting conditions, and care organization for healthy mothers who are at risk for chronic illness that stem from child birth are some situations that best fit the pay for coordination reimbursement model. Defined by Kongstvedt (2007) , “Pay for performance reimbursement model can be defined as a payment or financial incentive associated with achieving defined and measurable goals related to care processes and outcomes, patient experience, resource use, and other factors.” (p. 104). Pay for performance are services for which metrics already exist including management of some chronic conditions and certain surgeries. An example of when the pay for performance reimbursement model is the best match is programs that that reward improvement in hospitals that decrease the rate of readmissions. Episode payments are single payments for a group of services related to a treatment or condition that may involve multiple providers in multiple settings. These are some types of care that can be best fit for episode or bundled payments kidney transplants, maternity care, open heart surgery, some ambulatory diagnostics or therapeutic