DNP 840 Topic 2 Discussions 1 and 2

DNP 840 Topic 2 Discussions 1 and 2

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Topic 2 DQ 1 What are three payment structures used in the health care industry across the care continuum? How are they similar? How are they different? Is there a single problem that transverses all three of the identified payment structures? Explain.

SAMPLE ANSWER

Payment structures used in the health care industry

Introduction

For years, the health care industry has been relying on fee for service to determine how much money it should pay doctors and hospitals. However, this model is becoming outdated as more people turn to insurance plans that bundle together multiple services into one monthly payment. In addition, capitation payments allow insurers to track how well providers do at providing care for their patients over time—and this information can help them make informed decisions about what kind of coverage will work best for each patient’s needs.

Fee for service

Fee for service is a payment structure in which providers are paid on the basis of each service they provide. The provider can choose the services they provide, level of services provided and patients served. The fee can be based on either flat rate or per visit/hourly rate with no cap on total billings.

Fee for service payment structures are most often found in primary care settings such as family medicine offices or urgent care centers where patients may see multiple providers during their visit and require multiple tests or treatments over several days. This type of billing arrangement helps keep costs down because there’s no cap on how much money you can make from your practice; however it also means that if you take on too many patients at once (or don’t keep up with them), then you won’t get paid enough to cover all those bills!

Discount model

The discount payment structure is a type of payment structure in which the provider’s reimbursement is linked to the cost of care incurred by the patient. In this model, providers receive a fixed amount for each patient regardless of what services are provided. In some cases, this could be as little as $1.00 or less per visit or procedure and there may be no cap on how many patients can receive discounted care from one health care provider at any given time; however due to regulations around patient volume limits (see below), it’s often impossible for these types of programs (also known as “fee-for-service”) because they’re designed specifically to avoid any kind of cap on how much money you can make off selling someone else’s blood or urine samples!

Capitation

Capitation is a payment structure that provides a fixed amount of money to the health care provider for each patient enrolled in the plan. The capitation payment is not based on any type of premium or co-payment, but rather on how much care you use. This can be beneficial because it’s less expensive than other types of payments such as fee-for-service, which bases your reimbursement rate on what services you provide and how many times they’re performed per year.

The provider will get paid this same amount regardless if they see one patient or 100 patients per month—it’s just an investment in your practice’s productivity instead of paying out more when there are more people using services at once (which would mean lower rates).

Bundled payment

Bundled payment is a method of paying for health care that bundles together several services into one payment. Bundled payments are different from fee-for-service in that they do not pay providers per service, but rather pay them a single amount for all related services. For example, if you have surgery and then need an additional procedure on your shoulder later on, you would be responsible only for the cost of this one additional procedure instead of having to pay separately for each service as with fee-for-service.

Understanding payment structures can help when you’re deciding what kind of health insurance policy to choose.

When you’re deciding what kind of health insurance policy to choose, it’s important to understand the payment structures that are available. These payment structures can affect how much you pay each month and how quickly your payments will be processed.

Here are some examples of payment structures:

Conclusion

As you can see, there are many different payment structures in the health care industry. Each of them has its own pros and cons, but ultimately, it’s up to you which one will best suit your needs as an individual or family.