Changing Reimbursement Environment Based on Clinical Quality
Pay for performance is an approach to reimbursement within the clinical environment in which a provider is compensated based on safety and quality of care, and client satisfaction. It should be noted that the complexity of the set lies in the fact that the focus is shifting towards attempts to provide the best of care to patients but at the lowest cost possible.
Healthcare providers are trying to deliver value to patients since this ensures client satisfaction, and they are reimbursed based on this factor. Thus, to ensure value-based delivery and achieve cost-effectiveness, healthcare institutions need to use innovative methods. In addition, the changing environment indicates that compensation will be linked to clinical outcome measures stronger, which is likely to result in revenue reductions. This is due to the fact that insurance companies will route clients to quality providers, and the number of patients will inevitably decrease.
A possible scenario in which reimbursement may be potentially influenced by patient outcomes is an example of handling female clients with endometriosis. In particular, treating the growing number of such patients may become a challenge for healthcare institutions. Value-based reimbursement depends on insurers; the approaches utilized by service providers at the moment require them to refer patients to subsequent services, which implies poorer outcomes for the client but better results for the institution.
That is, providers will need to resort to innovation to be able to offer effective treatment to women with endometriosis. Individual procedures will append additional costs for the client with a minor benefit for them, which is not effective in terms of reimbursement based on patient outcomes.