Payment Methods Influence Healthcare Providers’ Service

How are Physicians Paid?

Payment methods vary from case to case depending on the PHO’s employment setup. Albeit PHO is a partnership between physicians and hospitals, these associations are still two separate businesses that have their own goals and are compensated differently. But at the physician’s level, they are paid based on certain determinants such as medical specialty, productivity, and performance. Due to a flux of myriad patient needs, a few physician remuneration structures have been designed to align behavioral incentives with healthcare objectives.



Initially, the principle behind the different payment processes is to offer an accessible healthcare system to the general populace, one that focuses on patient satisfaction and continuity and quality of care. Each of them is essentially a care model that physicians refer to make a better patient experience and over the years, they have relied on the following schemes:

Fee for service (FFS)

The fee-for-service (FFS) system is one of the earliest and most commonly used payment methods. Physicians are rewarded on a “per item of service provided” basis. Each provision is paid for and with it, physicians are inclined to render high quantities of medical activities and procedures. Physicians most likely see FFS as a suitable care initiative for long-term, chronic diseases that can only be managed over frequent check-ups and visits.

Capitation

Capitation offers a “payment per patient per time period” scheme. It is a fixed amount that physicians receive based on the agreed contract’s range of services, the number of patients, and the defined time, which can be monthly or yearly. This allows physicians to ensure that patients are given optimal care through specific health plans, all the while controlling costs.

Pay for performance

With the objective to enhance the quality of care, pay-for-performance (P4P) or otherwise known as value-based care, pays physicians according to how successful they are with certain clinical targets at the patient-population level. The shift to value from quantity in healthcare switches every physician’s goals to delivering efficient and effective patient outcomes.

Salary

Salary is also another physician payment process with a fixed amount. But unlike capitation, the salary is on a “per period of time” basis. Meaning, it is not dependent on the number of health care activities nor the number of patients. Without too many factors for physicians to take up, this can increase disease prevention, health promotion, and professional collaboration through a focused care service.

Self-pay

In this process, the patient personally chooses out-of-pocket spending to opt out for high-deductible health plans (HDHP). Physicians charge a reasonable fee for their service based on their business model. This allows members to have the option to only pay for medical treatments without paying for premiums, which provides a significantly better healthcare experience and financial flexibility.

Each physician payment is patterned after the needs of every patient and complex specialty. As a result, the compensation they receive encourages an improved quality of service delivery and care coordination in healthcare.

QuickCap Can Process Different Healthcare Payments

The healthcare industry has implemented changes to alter and offset challenges in providing quality healthcare. And QuickCap has been following the progress, continuously upgrading its system to better the healthcare provider and payer’s workflow with the following payment management platforms:

• Contracting. Create contracts that define provider payment specifications and service fees with ease.
• Capitation. Efficiently calculate, configure, and pay capitation and specialty rates through different payment methods according to your contract.
• Claims Payment Processing. Process and send claims to third-party payers in one place.
• Claims Adjudication. Streamline claims adjudication process and receive payments on time.

Different payment processes are complicated but QuickCap can simplify and speed up operations, making everything easy and convenient for every physician to promote care coordination in healthcare.

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