Please discuss the difference between prospective and retrospective payment system

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• Please discuss the difference between prospective and retrospective payment system.
  1. Prospective payments allow a payer to pay providers a pre-determined price at the time of service (Ross, n.d.) It is a type of reimbursement from Medicare payment that is based on a fixed price. The intention of this payment is to motivate providers to provide a quality care for their patients. Moreover, Medicare prospective payment system (PPS) has been changed, and instead of family receiving monthly premium to cover the whole family, the health care facilities receive a single payment for the single beneficiary to cover a specific period or the entire hospital stay (American Speech-Language-Hearing Association, n.d.)
     1. Retrospective payment allows a payer to adjust payment to meet a bundled rate for the related procedures. This gives health care providers influence over payment rates rather than having a fixed amount. The provider will send the bill to the insurance company based on the services provided.
  2. Please identify and describe three payment reform initiatives in the Patient Protection and Affordable Care Act.
  3. The three-payment reform initiative in PPACA are:
     1. -Patient-Centered medical homes – this initiative use multidisciplinary teams and advanced tools to provide centered care for the patient. This is often organized by the health plans, and medical groups to create an environment for primary care services to transform themselves into patient-centered (Edwards, Bitton, and et al, 2009).
     2. Accountable Care Organizations (ACOs) – This is a group of doctors, hospitals and other providers who team up to give coordinated high-quality care for Medicare patients. This prioritizes patients by providing right care at the right time and avoid unnecessary duplication of services to prevent medical errors (Center for Medicare and Medicaid Services, n.d)
     3. Bundled Payments – a single payment to providers or health care facilities for all services to treat patient’s conditions. The payments are made to the provider depending on the expected costs for each episode (Delbanco, 2014).
  4. Will there ever be (in your opinion) an acceptable solution for providing Health-Care Insurance to all?
  5. In my opinion, I could see a possibility that health care should be accessible by all Americans for free. I mean, other countries can do so, why can’t America? Of course, there will be challenges and changes if that is to happen. The government spending will increase, which also means that everyone could be paying more than they should.
  6. Do you feel it is acceptable to expect “the haves” to provide Health care Benefits for the “have nots” through the expansion plans for Medicaid?
  7. Medicaid program has helped millions of Americans to afford health care at lower cost or for free. Health care is very important in everyone life, and they should be given an opportunity to get health coverage.
  8. Is there a necessity for patient education with respect to insurance, both for private and government coverage? How should a patient education program be structured and delivered?
  9. Everyone should be educated on how private and government insurance works. The community should provide this education, because not many have access to internet, or some people cannot read. They should be guided by the community on what resources are available for the community.
  10. American Speech-Language-Hearing Association. (n.d.). Medicare Prospective Payment Systems (PPS) a Summary.
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  the difference between prospective and retrospective payment systems are:Prospective payments- The prospective payment system is a method of reimbursement in whichMedicare payment is made based on a predetermined, fixed amount (CMS, 2019). The paymentamount for a service is derived based on classification system of that services (CMS, 2019). It isa 468-diagnosis related group.Retrospective payment system- is the traditional reimbursement method, whereby fees for thedelivery of health care services is delivered organizations (Stanhope & Lancaster, 2016).Organizations are reimbursed by changes and services.Affordable Care Act & Payment ReformThe Affordable Care Act was passed to improve quality and lower health care costs, provideaccess to care and provide for consumer protection.Bundled PaymentsProviders and/or healthcare facilities are paid a single payment for all services performed to treata patient undergoing specific episode of care (Adams, 2015).Global PaymentsGlobal payments are usually paid to a single health care organization, and cover a wider array ofservices for a larger population of patients over a longer period (Adams, 2015).Accountable Care OrganizationThis was formed by health care providers. These health care providers agree to takeresponsibility for the quality and total cost of care for a population of patients (Adams, 2015).Health Care for AllIn my opinion, there are already acceptable solutions. Medicaid and Medicare could work foreveryone. I think most providers do not prefer this because it would lessen the money in theirpockets being that the rules of Medicare are rigid. However, the laws that govern Medicare andMedicaid can change at any time. It could be made into an actual policy for working Americans,and they can pay a monthly or biweekly premium to help aid the funding.Have and Have NotsI believe that health care should be a right. I do believe the “haves” should contribute in someway to help provide insurance for all. Without optimal care, some are enduring long sufferingand turn to other habits to try to manage failing health. I think it’s important to recognize howpeople without health care are affected.Patient EducationPatient education about insurance is of the utmost importance. I can tell you that I was able toteach my mother things about Medicare since taking this course. A lot of patients do not have theunderstanding when it comes to their insurance and prices of health care. It should be structed toexplain to individuals how to use insurance and what services are covered. First start by givingan introduction and letting people know what the benefits are. They will need to be taught aboutdeductibles, meeting them, and how prices will change after doing so.
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