HCA 205 Week 2 Discussion 1 Reimbursement

HCA 205 Week 2 Discussion 1 Reimbursement

HCA 205 Week 2 Discussion 1 Reimbursement

Sample Answer for HCA 205 Week 2 Discussion 1 Reimbursement

The capitation payment system is a healthcare reimbursement technique that reimburses a physician, clinic, or hospital for services that they will render to a patient under the program in the future for a defined period (Chapter 3, N.d.). In so doing, it enables these services providers to attain immense financial benefits if they render minimal health services to the patient before the expiration of the defined period. This system exerts a significant positive influence on the overall healthcare system by obligating physicians, clinics, and hospital to provide patients with quality healthcare services to minimize their hospital revisits or readmission hence amass substantial financial gains.

The capitation payment system gained popularity in the 1980s and 1990s due to pressure from both the U.S. government and private insurers to adopt a mechanism that would reduce the bloated cost of health care in the country (James & Poulsen, 2016). The tool proved integral as it enabled these institutions to curb healthcare expenditure by reimbursing health providers with specified fees for every patient for a defined period. Moreover, its avocation for patients to receive limitless healthcare services further enhanced its relevance by not only improving their access to care but also obligating care providers to provide them with quality healthcare to minimize hospital revisits and patient readmissions.

The capitation model has profoundly exerted a positive influence on the cost, quality, and access to healthcare service. By reimbursing physicians, clinics, and hospitals before the delivery of health care services, the model enables them to obtain the requisite resources necessary for the provision of quality care to patients under the program hence improving healthcare costs (Chapter 3, N.d.). Also, the program advances quality by obligating practitioners to provide patients with sound care to minimize hospital revisits or patient readmissions. Moreover, it permits access to care by ensuring that beneficiaries obtain the necessary health care services for as long as they may desire during the insurance period.

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Sample Response for HCA 205 Week 2 Discussion 1 Reimbursement

Hey Qiana, 

 Thank you for sharing your views on Capitation reimbursement method. However, your method is not the best method of reimbursement. The Capitation reimbursement method does not work for all hospitals, PCP, or patients. Capitation is only good for two major groups which are employers and those who utilize HMO insurance policies. However, providers are negatively impacted if one is chosen more so than the other because the one who uses the least amount of services generally gets compensated more. Employers utilize the capitation method because it provides them with a fixed rate for employee insurance coverage. Capitation provides incentives to hospitals and PCP to give fewer services to patients in order to gain more profits. That isn’t in the best interest of the patient and it only works for the provider. It isn’t a method that works for both parties. That’s precisely why fee-for-service is still the best method of reimbursement. The cost of fee-for-service is cost effective and direct. The quality of services provided are geared towards helping patients obtain services and know what those services cost. They are being treated with more care and are not in a race for compensation over the quality of care. They have access to every service they need. Fee-for-service was the first method of reimbursement created and is still used to this day because of it’s efficiency. It works for everyone. 


Chapter 3. (N.d.). Healthcare Financing and Reimbursement. 

Pearce J.W., (2012) Healthcare Financial Management: Journal Of The Healthcare Financial Management Association 

Sample Response for HCA 205 Week 2 Discussion 1 Reimbursement



The Capitation model seems like a strong reimbursement method.  Any method that gives incentives to doctors for providing efficient, quality care is good.  According to Batnitzky, (2018) “The provider profits if fewer services are used. However, if more services are used, the provider absorbs the cost.” (p. 61) This  This is where capitation falls short in my opinion.   When a hospital is forced, sometimes out of their own control to provide care that exceeds the annual payment contract they are the sole bearer of that cost.  depending on patient load, and the type of illnesses can greatly affect a hospitals profitability and cause a potentially huge change in year to year business plans.  The newer reimbursement types like pay-for-performance take away the fixed payment.  they add bonuses to providers for quality care and meeting certain standards, while still being penalized for sub par performance and not meeting standards.  The difference being that hospitals performance can dictate profits or penalties, and not being penalized for participating in a capitation type program. 


Reference: Batnitzky, A., Hayes, D., & Vinall, P.E. (2018).The U.S. healthcare system: An introduction[Electronic version]. Retrieved from https://content.ashford.edu/Links to an external site. 

Method 1: Fee-For-Service (last names A-H) In your initial post:

Examine how this reimbursement model has positively influenced the overall health care system.

Identify how this reimbursement model evolved as a solid and crucial part of the health care system.

Determine how this reimbursement model has positively influenced cost, quality, and access of care.

Guided Response: Review at least two of the other methods posted by your classmates. Respond to at least two of your classmates who have posted an argument for two of the other methods. In your responses:

Examine how your classmates’ model has a more negative influence on the health care system than the other models.

Identify how your classmates’ model has a weaker foundation for being part of the health care system (i.e., historical value of yours vs. theirs).

Determine how your classmates’ model has negatively influenced cost, quality, and access of care in comparison to your model.

Manage Discussion Entry

The capitation system has failed the healthcare system because it is a waste of money to pay the provider for a service that has not been administered.  The capitation reimbursement method is when the insurance company pays the provider a fixed rate regardless of how many times the patient visits the physician.   It doesn’t matter if the patient does not see the doctor for a few months, the doctor will still get reimbursed.  I think this is not smart for the healthcare system and is a waste of healthcare money.  If the same person was on a pay-per-service healthcare plan, then that same person would only pay the provider for the services provided by that physician.  I think the patient would not get the best of care using the capitation insurance plan because the doctor knows that he/she will still get paid regardless.  If the doctor knows that the patient is coming to him/her on an as-needed basis they will definitely want you to keep coming back, so they will provide you with the best of care.  The physicians providing care under the capitation process don’t have to provide quality care because they are on a fixed rate and will get reimbursed no matter what.  This is not good for our healthcare system.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires alot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you sahould get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

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I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed

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