Government Incentive Programs and Alternative Settings

1 Government Incentive Programs and Alternative Settings The incentive programs used to inspire healthcare professionals to provide services that meet quality healthcare expectations are value-based purchasing, pay-for-performance, Independent Home Demonstration Program, and hospital consumer assessment of care providers.

The pay-for-service is an incentive program in which services are paid for separately.

This program gives physicians and other providers the incentive to provide more treatment and preventive services since reimbursement is based on the quantity of care rather than care quality.

This program, however, encourages providers to focus on efficiency and quality of services. The fee-for-service allows clients to freely choose hospitals and providers with minimal interference from the insurance company. However, clients may pay out of their pockets for the services not covered by the insurance provider.

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Under the hospital value-based purchasing program, the CMS rewards acute care facilities based on the quality of care delivered to Medicare beneficiaries (CMS, 2021). This program focuses on providing patient-centered care, improving patient safety, and reducing unnecessary costs. The value-based program offers the highest monetary value and quality return. Reimbursement, under this program, is done based on the quality of services and outcome of care.

The hospital consumer assessment of care providers and hospital systems (HCAHPS) is a program that gathers data from individuals on their perspective of healthcare services. This data is used in comparing different hospitals in sectors that are relevant to the consumers. Rivier University (2015) noted that the HCAHPS exerts financial pressure on institutions that lose income if they do not attain the projected score in the top half of all facilities The independent at-home demonstration is an incentive program authorized by the affordable care act. This program encourages care professionals to provide chronically ill persons with primary care services in home settings (CMS, 2019).

3 References CMS (2019). Independence at home demonstration. https://innovation.cms.gov/files/fact-sheet/iah-fs.pdf CMS (2021). The hospital value-based purchasing (VBP) program. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ Value-Based-Programs/HVBP/Hospital-Value-Based-Purchasing North, J. (2020). Private health insurance: History, politics, and performance. Cambridge University Press.

Rivier University (2015). The HCAHPS survey: How policies impact hospitals, patients and healthcare workers. https://www.rivier.edu/academics/blog-posts/the-hcahps-surveyhow-policies-impact-hospitals-patients-and-healthcare-workers/