Payor System Discussion HCA 675

Payor System Discussion HCA 675

Payor System Discussion HCA 675

What are the pros and cons of a DRG payor system, and a capitated payor system? If you were a health care czar, which one would you favor and why?

Re: Topic 2 DQ 1

DRG stands for diagnosis-related group.The idea behind DRGs is to ensure that Medicare reimbursements adequately reflect “the fundamental role which a hospital’s case mix [ie, the type of patients the hospitals treats, and the severity of their medical issues] plays in determining its costs” and the number of resources that the hospital needs to treat its patients. The advantages of the DRG payment system are reflected in the increased efficiency and transparency and reduced average length of stay.The disadvantage of DRG is creating financial incentives toward earlier hospital discharges (Mihailovic,Kocic,& Jakovljevic,2016).

Capitated payment system is in which a doctor or hospital is paid a fixed amount per patient for a prescribed period of time by an insurer or physician association.It simplifies bookkeeping,discourages excessive billing or more costly procedures, and avoid unnecessary tests and procedures for patients.The disadvantages are providers may spend less time per patient and also incentivizes providing fewer services(Torry,T.2019).

If I were a health care czar, I would probably choose a capitated payor system. It’s the only payment system that fully aligns providers’ financial incentives with the goal of eliminating all major categories of waste. It fundamentally shifts the role of managing the amount, form, and cost of care from insurers to medical practitioners. It also ensures that providers receive enough of the savings that they can afford to fund the changes needed to bring down costs(James & Poulsen,2016).

James,B,C,.& Poulsen,G,P,.(2016).The Case for Capitation. Retrieved from .https://hbr.org/2016/

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: Payor System Discussion HCA 675

RESPOND HERE

This is a great work Maggie Paul. You have succinctly defined and differentiated DRG pay and capitated pay, including their pros and cons. Indeed, it is an indication that you had a better grasp of the topic. Adding to benefits of the preferred system chosen, which is capitated pay, the system can be more efficient and simple. The reason for this is that the only requirement to focus on is the number of enrolled members (Basu, Phillips, Song, Bitton & Landon, 2017). Further, the use intricate billing codes or the involving paper works is limited. Besides, it is easier for providers to predict cash flow and patients can also easily predict health care costs.

Reference

Basu, S., Phillips, R. S., Song, Z., Bitton, A., & Landon, B. E. (2017). High levels of capitation payments needed to shift primary care toward proactive team and nonvisit care. Health Affairs, 36(9), 1599-1605.

HCA 675 Grand Canyon Week 2 Discussion 2

Discuss the impacts of a large portion of the population being uninsured and how this affects the health care system. If this continues, how do you anticipate that the health care system will respond to it? What are the ethical issues and the practical ones?

Re: Topic 2 DQ 2

Having a large portion of the uninsured population has a bad impact on the health system. When one or more members lack health insurance it affects the whole family. Studies shows lacking health insurance cause a variety of personal health-related outcomes. It negatively affects the children’s developmental status, access to and use of health services. Use of health services become financial. Medical bill problems also disproportionately affect sicker populations. Three-fourths of adults 18-64 (76 percent) who do not have health insurance say they or a family have postponed or put off care due to costs. The most common experiences reported by the uninsured include relying on home remedies or OTC drugs (57 percent), postponing needed care (50 percent), or skipping dental care or checkups (47 percent) (Kirzinger,.Munana,& Broodie.2019). ED crowding remains a growing national problem. Having higher the proportion of uninsured people can results in states with higher needs, but less revenue to pay for services. Such conditions could lead to great revenue crunch that’s similar to the Great Recession, (Rovner,J.2017).

There are many ethical problems due large uninsured population. One such problem is how to distribute coverage or care equally? A mandate to maintain coverage will impose a substantial economic burden on some people, particularly those who purchase coverage but do not qualify for subsidies. The market-based reform grants would help only some of the most vulnerable members of society—those who are sick and those who are poor. A study by Han et al (20160 found reduced access to care due to Insurance-based bias. Once they do visit the doctor, poor, uninsured people often report racial discrimination when communicating with health care professionals.

Addressing health care costs and coverage has become the top priorities for voters .There is a tensions exist between many health policy goals,- expanding coverage versus reducing costs; targeting tax credits effectively versus incentivizing work; protecting the sickest and most expensive patients versus preserving choice among the majority of patients who may not need comprehensive coverage; and limiting the federal government’s cost liability versus minimizing cost-shifting to consumers and states. Deciding among these goals or striking a balance across them will involve political and value calculations about what the U.S. healthcare system should look like (Eibner, & Hussay .2019).

Eibner,C,.& Hussay ,P,S,.(2019) The Future of U.S. Health Care: Replace or Revise the Affordable Care Act? Retrieved from https://www.rand.org/health-

Rovner,J.(2017).Millions More Uninsured Could Impact Health Of Those With Insurance..Too.. Retrieved from .https://khn.org/news/millions-more-uninsured-c

Kirzinger,A,.Munana,C,. Broodie,M,(2019)Data Note: Americans’ Challenges with Health Care Costs. Retrieved from www.kff.org/

Han,X,. Call,K,T,. Pintor,J,K ,Alarcon-Espinoza ,G,. Simon,A,B (2016) Reports of Insurance-Based Discrimination in Health Care and Its Association With Access to Care .Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455519/

HCA 675 Grand Canyon Week 2 Assignment

Health Care Reform Paper

Write a paper of 1,000–1,200 words that lists the top five elements of the health care system that most need reform, in your opinion. Justify your choices through a logical analysis of the elements’ impact on the current system.

Refer to the assigned readings to incorporate specific examples and details into your paper.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.