|
Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care. Similarly, when patients are shielded from paying (cost-sharing) by health insurance coverage, they are incentivized to welcome any medical service that might do some good. FFS is the dominant physician payment method in the United States,〔 it raises costs, discourages the efficiencies of integrated care, and a variety of reform efforts have been attempted, recommended, or initiated to reduce its influence (such as moving towards bundled payments and capitation). In capitation, physicians are discouraged from performing procedures, including necessary ones, because they are not paid anything extra for performing them. In the Japanese health care system, FFS is mixed with a nationwide price setting mechanism (all-payer rate setting) to control costs. ==Health care== In the health insurance and the health care industries, FFS occurs when doctors and other health care providers receive a fee for each service such as an office visit, test, procedure, or other health care service.〔(FEHB Glossary. ) Retrieved May 31, 2006.〕 Payments are issued retrospectively, after the services are provided.〔 FFS is inflationary, raising health care costs. It creates a potential financial conflict of interest with patients, as it incentivizes overutilization—treatments with either an inappropriately excessive volume or cost. FFS does not incentivize physicians to withhold services.〔 When bills are paid under FFS by a third party, patients (along with doctors) have no incentive to consider the cost of treatment. Patients can welcome services under third-party payers, because "when people are insulated from the cost of a desirable product or service, they use more". Evidence suggests primary care physicians who are paid under a FFS model tend to treat patients with more procedures than those paid under capitation or a salary. FFS incentivizes primary care physicians to invest in radiology clinics and perform physician self-referral in order to generate income.〔 Private-practice physicians and small group practices are particularly vulnerable to declining reimbursement for patient services by government and third-party payers. Rising regulatory demands, such as the purchase and implementation of costly EHR systems, and increasing vigilance by government agencies tasked with identifying and recouping Medicare fraud and abuse, have bloated overhead and cut into revenue. While most practices have succumbed to the need to see more patients and increase FFS procedures to maintain revenue, rising numbers of physicians are looking to alternate practice models as a better solution. In addition to value-based reimbursement models, such as pay-for-performance programs and accountable care organizations, there is a resurgence of interest in concierge and direct-pay practice models.〔("Healthcare Reform Influencing Physicians' Career Choices" ) Aubrey Westgate, Physicians Practice, September 2012.〕 When patients have greater access to their physicians and physicians have more time to spend with patients, utilization of services such as imaging and testing declines. FFS is a barrier to coordinated care, or integrated care—exemplified by the Mayo Clinic—because it rewards individual clinicians for performing separate treatments.〔 FFS also does not pay providers to pay attention to the most costly patients,〔 ones that could benefit from interventions such as phone calls that can make some hospital stays and 911 calls unnecessary.〔 In the United States, FFS is familiar to doctors and patients, as it is the main payment method.〔 Executives regret the changes to managed care, believing it, FFS, turned "industrious, productivity-oriented physicians into complacent, salaried employees." General practitioners have less autonomy after switching from a FFS model to integrated care. Patients, when moved off of a FFS model, may have their choices of physicians restricted, as was done in the Netherlands in their attempt to move towards coordinated care.〔 When physicians cannot bill for a service, it serves as a disincentive to perform that service if other billable options exist. Electronic referral, when a specialist evaluates medical data (such as laboratory tests or photos) to diagnose a patient instead of seeing the patient in person, would often improve health care quality and lower costs. However, "in the private fee-for-service context, the loss of specialist income is a powerful barrier to e-referral, a barrier that might be overcome if health plans compensated specialists for the time spent handling e-referrals". In Canada, the proportion of services billed under FFS over the period of 1990 to 2010 shifted substantially.〔 Less care was paid out for patients under the age of 55 while for those over 65, payment for diagnostic services was sharply increased. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Fee-for-service」の詳細全文を読む スポンサード リンク
|