Competency

Evaluate the current financing and reimbursement models within the U.S. healthcare delivery system.

Student Success Criteria

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Scenario

The Titusville Medical Center, a mid-sized, 300 bed, not-for profit hospital, has hired you as an expert consultant for healthcare financing. They have requested an executive summary that explains to their senior leadership (administrators and medical staff) the current financing and reimbursement models within the U. S. healthcare delivery system. Titusville is on the verge of buying either Jackson or Abigail Hospital and must understand financing and reimbursement models in order to know the best acquisition to consider.

Jackson Hospital is a 300 bed, not-for-profit, serving an urban, low-income population. Accepts all government payer types and most private insurances. Specialty populations served include hospice, rehabilitation, wound care, cancer care, and hospital-based imaging center.

Abagail Hospital is a 400 bed, for profit serving an urban, middle-income population. Accepts all government payer types and most private insurances. Specialty populations served include psychiatric, rehabilitation, and cancer care.

Instructions

Compose an executive summary that provides an in-depth analysis of the changing dynamics of healthcare reimbursement and the associated funding sources. Your executive summary should include an examination of the current financing and reimbursement models within the U.S. healthcare delivery system in order to help the merger committee decide whether to acquire either Abigail or Jackson Hospital. Among the most common reimbursement models are capitation, Pay-for- Performance (P4P), bundled payments, Accountable Care Organizations (ACOs), Patient-Centered Medical Homes (PCMH), Fee-for-Service (FFS), Shared Savings, and Shared Risks.

Be sure that the executive summary includes eight types of healthcare payment models (of at least two paragraphs each) as well as a title and reference page.

For each model, include a description of:

• The incentive(s) and drawback(s) for healthcare providers using the model
• The incentive(s) and drawback(s) for patients who have providers using the model
• Required quality metrics or performance measures for applicable models