HCA 205 Week 2 Discussion 1 Reimbursement Debate
University:
Grand Canyon University
HCA 205 Week 2 Discussion 1 Reimbursement Debate
Paper Instructions
There are four specific reimbursement methods in our healthcare system. For this discussion, you will make your initial post on one of the four methods of reimbursement and will make responses to two of the other three methods of reimbursement posted by your classmates. The reimbursement method you will be discussing in your initial post depends on the first initial of your last name.
See the table below, and then post an argument on your topic that explains why your method of reimbursement is the best method for the U.S. healthcare system. You and each of your classmates will also post rebuttals to one person from two of the other methods – staying focused on the argument for your specific reimbursement method.
For help, review the Understanding Insurance Models game in the Chapter 3 Summary section of your textbook.
Students with last names starting with A–H are assigned to Method 1. Support fee-for-service throughout this discussion; submit rebuttals to two of the other Methods (2, 3, or 4).
Students with last names starting with I–M are assigned to Method 2. Support capitation throughout this discussion; submit rebuttals to two of the other Methods (1, 3, or 4).
Students with the last names starting with N–R are assigned to Method 3. Support pay-for-performance throughout this discussion; submit rebuttals to two other Methods (1, 2, or 4).
Students with the last names starting with S–Z are assigned to Method 4. Support the value-based model throughout this discussion; submit rebuttals to two other Methods (1, 2, or 3).
Your original post should be at least 250 words with at least two scholarly sources that support your view. Your rebuttals should be at least 150 words with at least one scholarly source supporting your rebuttal.
Example
You are assigned to Method 1— fee-for-service. Your original post discusses why the fee-for-service model is best for the U.S. healthcare system. Your response posts will refute two of the other methods on the other topics by stating why fee-for-service is better than capitation, pay-for-performance, or the value-based model. You need to include justification for your response.
Method 1 Fee-For-Service (last names A-H)
In your initial post:
- Examine how this reimbursement model has positively influenced the overall health care system.
- Identify how this reimbursement model evolved as a solid and crucial part of the health care system.
- Determine how this reimbursement model has positively influenced cost, quality, and access of care.
Guided Response
Review at least two of the other methods posted by your classmates. Respond to at least two of your classmates who have posted an argument for two of the other methods. In your responses,
- Examine how your classmates’ model has a more negative influence on the health care system than the other models.
- Identify how your classmates’ model has a weaker foundation for being part of the health care system (i.e., historical value of yours vs. theirs).
- Determine how your classmates’ model has negatively influenced cost, quality, and access of care in comparison to your model.
Method 2 Capitation (last names I-M)
In your initial post:
- Examine how this reimbursement model has positively influenced the overall health care system.
- Identify how this reimbursement model evolved as a solid and crucial part of the health care system.
- Determine how this reimbursement model has positively influenced cost, quality, and access of care.
Guided Response
Review at least two of the other methods posted by your classmates. Respond to at least two of your classmates who have posted an argument for two of the other methods. In your responses
- Examine how your classmates’ model has a more negative influence on the health care system than the other models.
- Identify how your classmates’ model has a weaker foundation for being part of the health care system (i.e., historical value of yours vs. theirs).
- Determine how your classmates’ model has negatively influenced cost, quality, and access of care in comparison to your model.
Method 3 Pay-For-Performance (last names N-R)
In your initial post,
- Examine how this reimbursement model has positively influenced the overall health care system.
- Identify how this reimbursement model evolved as a solid and crucial part of the health care system.
- Determine how this reimbursement model has positively influenced cost, quality, and access of care.
Guided Response
Review at least two of the other methods posted by your classmates.
Respond to at least two of your classmates who have posted an argument for two of the other methods. In your responses;
- Examine how your classmates’ model has a more negative influence on the health care system than the other models.
- Identify how your classmates’ model has a weaker foundation for being part of the health care system (i.e., historical value of yours vs. theirs).
- Determine how your classmates’ model has negatively influenced cost, quality, and access of care in comparison to your model.
Method 4 Value-Based Model (last names S-Z)
In your initial post,
- Examine how this reimbursement model has positively influenced the overall health care system.
- Identify how this reimbursement model evolved as a solid and crucial part of the health care system.
- Determine how this reimbursement model has positively influenced cost, quality, and access of care.
Guided Response
Review at least two of the other methods posted by your classmates.
Respond to at least two of your classmates who have posted an argument for two of the other methods. In your responses,
- Examine how your classmates’ model has a more negative influence on the health care system than the other models.
- Identify how your classmates’ model has a weaker foundation for being part of the health care system (i.e., historical value of yours vs. theirs).
- Determine how your classmates’ model has negatively influenced cost, quality, and access of care in comparison to your model.
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Sample Answer
The capitation payment system is a healthcare reimbursement technique that reimburses a physician, clinic, or hospital for services that they will render to a patient under the program in the future for a defined period (Chapter 3, N.d.). In so doing, it enables these services providers to attain immense financial benefits if they render minimal health services to the patient before the expiration of the defined period.
This system exerts a significant positive influence on the overall healthcare system by obligating physicians, clinics, and hospital to provide patients with quality healthcare services to minimize their hospital revisits or readmission hence amass substantial financial gains. The capitation payment system gained popularity in the 1980s and 1990s due to pressure from both the U.S. government and private insurers to adopt a mechanism that would reduce the bloated cost of health care in the country (James & Poulsen, 2016).
The tool proved integral as it enabled these institutions to curb healthcare expenditure by reimbursing health providers with specified fees for every patient for a defined period. Moreover, its avocation for patients to receive limitless healthcare services further enhanced its relevance by not only improving their access to care but also obligating care providers to provide them with quality healthcare to minimize hospital revisits and patient readmissions.
The capitation model has profoundly exerted a positive influence on the cost, quality, and access to healthcare service. By reimbursing physicians, clinics, and hospitals before the delivery of health care services, the model enables them to obtain the requisite resources necessary for the provision of quality care to patients under the program hence improving healthcare costs (Chapter 3, N.d.).
Also, the program advances quality by obligating practitioners to provide patients with sound care to minimize hospital revisits or patient readmissions. Moreover, it permits access to care by ensuring that beneficiaries obtain the necessary health care services for as long as they may desire during the insurance period.
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