Tag Archives: fee for service

How we pay our Doctors

2 Mar

Before the health insurances era Doctors were often payed in nature with eggs, chicken or other farm products. Needless to say that they were often poorly paid, furthermore people called them so lately that the care was unable to keep them alive and the doctors lost their patients in the same time. Once the Doctors and the people they cared got the health insurances to be created Doctors received currencies for their services and could see more than once their patients. The issue of payment was transferred to the insurer. In the beginning insurers reimbursed with a fee for service model like the patients did previously. But the increasing amount of money needed made them think of an alternative payment model. And here came the Pay for Performance model.

France has already put in place such a payment model here:
http://www.csmf.org/upload/File/Conv_med/conv_med_annexes_110726.pdf

USA will implement this mode of payment in 2019 here:
http://www.medpagetoday.com/PublicHealthPolicy/Medicare/40568

Developing countries have already experienced these kind of payment here:
http://www.esciencecentral.org/journals/impact-of-pay-for-performance-on-utilization-of-health-services-and-quality-of-care-in-low-and-middle-income-countries.hccr.1000116.pdf

Below are other links related to the way Doctors will be payed in the future:

http://theincidentaleconomist.com/wordpress/can-the-better-care-lower-cost-act-live-up-to-its-name/

http://advocacyblog.acponline.org/2013/07/house-sgr-bill-promotes-medical-homes.html?utm_source=twitterfeed&utm_medium=twitter&utm_campaign=Feed:+AcpAdvocateBlog

http://advocacyblog.acponline.org/2013/04/does-measurement-improve-performance.html

http://doctorscaucus.gingrey.house.gov/news/documentsingle.aspx?DocumentID=364922

http://energycommerce.house.gov/markup/markup-committee-print-amend-title-xviii-social-security-act-reform-sustainable-growth-rate

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P4P for French primary care physicians for the first time of their history

26 Jul

For the first time of their history, French primary care practitioners will be paid for performance. Until now their remuneration was only of “fee for service” type. But the new contract with social security scheme of July 2011 introduces a dose of “pay for performance”. Goals that will have to be reached in order to receive bonuses will be fixed by the contract negotiated with the French national social security scheme.

Old time when practitioners only had an obligation of mean is from now on a past history. Bonuses are now also paid for the obtaining of results.

The risk of such a new remuneration is that it only add on to the previous one “fee for service” remuneration without address the problem of repetitive un-necessary medical cares.

Pay for performance should potentially show better results in a salaried context like in England than in a fee for service context like it is in France.

Furthermore patients with multiple chronic diseases often do not correspond to any guidelines available.  But… wait and see.

All the more, results depend on how generous will be the financial incentive and how high will be set the performance thresholds. From now on bonuses costs are estimated between 360 and 380 million Euros.

HMO or ACO?

9 Jul

In the USA after the HMO (Health Management Organisation) here comes the ACO (Accountable care Organisation). Physician don’t accept to be aligned with hospitals. What is the best : fee for service (physician) or fee for organisation (hospitals). Both have their advantages. In France instead of alignment with prefer private/public complementarity and hospital are financed with a mix of fee for service (PMSI) and fee for organisation (Global budget).

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