SLP(PayingFor Hospital And Physician Services)
[Name of the Institution]
SLP(PayingFor Hospital And Physician Services)
Part I – Paying For Hospital Services
Fee-For-Service
Advantages
It is the most flexible and reliable healthinsurance accessible for the clients of healthcare. The significantadvantage is that patient does not have to wait for the consultant orspecialist and the doctors are available whenever and wherever theclient needed, as well as available out of state for the healthinsurance.
Disadvantages
The biggest disadvantage is the highestpremium price and is considered as the most expensive insurancepolicy. Uninsured cost should be provided before the date ofco-payment. Furthermore, the insurance company will not pay back theamount for the service charges, and the premium member has to payapproximately 20% to 25% of their treatment operating cost. Membersare responsible for paying the service charges out of their pocketunless the company compensates it. Members are ultimately responsiblefor the procedure of their claim form and individually accountablefor all the paperwork related to their medical concerned and issues.
Per Diem
Advantages
The main advantage of per diam is theopportunity to make the extra money that depends on their commitmentlevel with their profession. Time flexibility is another bestadvantage, a person can choose their schedule according to thescenario and commitment. Even, a person has the choice to select theno commitment day and choose even a little time to work. Both, timeflexibility and opportunity of earning good money are the significantfeatures of per diam.
Disadvantages
The biggest disadvantage is the low benefits,sense of non-professionalism, and non-guaranteeing of availablehours. For example, I performed my duty as per diem, but in 10different places, and I did not have the facility of the mailbox .But, when I started work for only 1 place per diem then problemresolved.
DRG-Based Payment System
Advantages
The implementation of DRG-based payment systemis advantageous and have the positive influence on the technologicaltreatment because the overall financial capital is being justifiedfor the reduction of negligence. The reimbursement optimizationsystem of DRG has negatively effected the growth pattern,technological dispersion, and the compensation levels.
Disadvantages
With the numerous advantages of thehealthcare, the DRG system also develops a variety of challengesspecifically for the vendors and manufacturer of medical equipment.DRG system enables to gradually increase the treatment and purchasingtendency of the local hospital, that emphasizes to empowered thecheap purchasing, facilitating the cost and proportion of capitaland becoming challengeable for the expensive private hospital.
Capitation
Advantages
It enables the financial stability ofphysicians and assures the certainty of the income for each year.They provide an opportunity for the physicians to develop thelong-term relationship with the patient families and build up greattrust among them. Physicians develop the better understanding of thepatient medical histories and their requirement. Furthermore,physicians are permitted to give incentives for the providing highquality and well-organized services.
Disadvantages
In some of the cases, when the physicianswork under the capitation system can most probably lose the portionof their incentive and earning during the treatment of the complexpatient. That is the reason, physicians be liable to completelyignore the treatment of the complex cases and favorably choose thepatient with the easy treatment.
Part II – Paying For Physician Services
Difference Between Medicare Payment MethodsFor Outpatient Services And Physician Services
According to the report of Medicare`s HospitalOutpatient Prospective Payment System, it is stated: “Whenthe hospital outpatient services are provided outside the hospital`smain facility, a determination of provider-based status must be made.The main criteria for receiving this status center around issues ofcontrol of operations, physical proximity to the main providerlocation, and population served by the off-site facility as comparedwith the population served by the main facility”(Guidi,2013, p.n.d).
Accordingto the report of Medicare physician payment systems, it is stated:“CMS is alsorequired to establish by regulation each year’s payment amounts forall physician services paid under the Medicare Physician PaymentSchedule, incorporating geographic adjustments to reflect thevariations in the costs of furnishing services in differentgeographic areas”(ManchikantiL, 2012, p.n.d).
Furthermore, Medicarephysician payment systemsstates: “TheMedicare Physician Payment Schedule’s impact on a physician’sMedicare payments is primarily a function of 3 key factors: 1)RBRVS (Resource-Based Relative Value Scale) 2) GPCI (GeographicPractice Cost Indexes) 3) MCF (Monetary ConversionFactor)”(Manchikanti L, 2012, p.n.d).
Difference Between Bundled Payments AndGlobal Payments
A bundled payment explains as the group orsingle payment given to the healthcare providers for attaining thevarious services related to the sequential medical care. The reasonof sequential and episodic care is that some of the treatmentrequires the chronological procedures from beginning to ending. Aglobal payment is the pre-defined and the fixed payment is given tothe healthcare providers and mostly the services involves all thattreatment exhibits during the contract period for example: treatmentfor the 12 months or being adjusted according to the illnessduration. However, the major difference is that global payment is theoverall care irrespective of the patient condition, while the bundledpayment (Cromwell J, 2012, p.n.d).
References
Cromwell J, e. (2012). Costsavings and physician responses to global bundled payments forMedicare heart bypass surgery. – PubMed – NCBI. Ncbi.nlm.nih.gov.Retrieved 28 December 2016, fromhttps://www.ncbi.nlm.nih.gov/pubmed/10180001
Guidi, T. (2013). Medicare`sHospital Outpatient Prospective Payment System: OPPS 101 (part 1 of2). PMC.Retrieved 28 December 2016, fromhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988668/
Manchikanti L, e. (2012). Medicarephysician payment systems: impact of 2011 schedule on interventionalpain management. – PubMed – NCBI. Ncbi.nlm.nih.gov.Retrieved 28 December 2016, fromhttps://www.ncbi.nlm.nih.gov/pubmed/21267048
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