The Prometheus Payment Model

A recent argument among health care providers and payers is in regards to the level of patient care required for reimbursement. Some payers are now refusing to pay for services that are rendered twice due to the ineffectiveness of the initial treatment. I see this as a bittersweet policy because it could help to increase the accountability of physicians and providers but it also leaves a health institutions responsible to pay for expensive services if for some reason the first treatment wasn’t successful. This begs one to consider whether some of the unpaid claim will be put pushed back for the patients to pay for. “Right now you have 50 to 80 percent of diabetic patients with an encounter that is caused by and avoidable complication; yet it

To align this policy with the concept of guaranteed services there would need to be a clause that would restrict providers from turning patients away if services were being sought in relation to a re-do procedure. I also believe that some safe guards should be in place to protect health care institutions such as a list of services that would be exempt from this form of guarantee. A better approach may be the Prometheus Payment Model which would meet the current reimbursement status with the form of guarantee being adopted. The Prometheus Payment Model is one in which providers, payers, and patients are forced to work as a team to provide the best care and reduce avoidable complications by required payers and providers to split the cost of a mistake that could have been avoided (Parker-Pope, 2009). This reduced the burden on the health institution while also maintaining a level of accountability. The focus of health care is around patient care and from a health organization’s standpoint the challenge is how to provide the best possible care for the lowest cost. An example of the warranty approach suggested by the Prometheus Payment Model is a patient’s orthodontic treatment. When a patient get braces he/she is required to make so many appointments with the provider to monitor progress, but rather than paying for each individual visit there would be one charge for the entire period of care. If at the end of treatment the expected outcome is not achieved then the orthodontists would take care of it. The financial challenges for health institutions will only continue to grow more complicated but without the government and other payers backing down on their refusal to pay for re-admissions and re-do services it is up to the institution to come up with a plan to avoid these payment refusals. The Prometheus Payment Method is one that