Financial Regulations in Healthcare

Since the infirmary prospective payment system (PPS) was introduced in the mid-1980s, hospitals come to for been trying to develop a means by which they tincture align their fiscal incentives with those of their physicians. PPS boundarys hospitals to a fixed reimbursement fall embed on diagnosis, with some adjustment establish on the resources subroutine by the patients under certain checked circumstances. However, physicians remain reimbursed ground on a fee schedule, so that the more than they do, the more they deposit paid. Therefore, physicians do not have the same incentives to limit cost for interactment that hospitals do. Other health c ar providers; including treat homes, dialysis facilities, ambulatory surgery centers, and managed care plans, now share with hospitals that strain in incentives. These providers are struggling to keep a mode to align their incentives with those of their physicians. (Sadin, 2002) One method that is currently enjoying a subs tantive amount of interest is something called gainsharing or disease management programs. These programs are mean to give physicians a stake in unequivocal the entitys costs through financial incentives. This appears, at first glance, to be a natural reaction to the problem of divergent incentives. In each industry some other than health care, a gainsharing program would be simple to implement. However, the health care industry, because of its passing regulated environment, presents circumscribed challenges for implementing gainsharing programs.

(Imberman, 1995) The first of these challenges is the Stark fair play. Th e Stark law prohibits physicians who have a ! financial birth with an entity from referring patients for certain types of service to that entity. A gainsharing relationship would clearly be considered a financial relationship falling within the Stark law. Consequently, any hospital or other entity that provides designated health services must find an applicable exception. The moreover exception that has the potential to validate a gainsharing... If you want to get a full essay, order it on our website: OrderCustomPaper.com

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