Which payment model relies on historical data to determine payment amounts?

The choice of discounted fee-for-service payment models relies on historical data to determine payment amounts based on the services that have been provided in the past. This method involves a standard fee schedule where payments for services are adjusted based on historical trends, patient volume, and typical payment rates from previous years. Providers are then reimbursed a percentage of the fee for each service rendered, usually at a reduced rate compared to the full fee.

Understanding the role of historical data is essential, as it allows for the assessment of the average costs and adjustments in pricing based on previous utilization trends and market adjustments. This approach contrasts with models that may rely on future predictions or fixed rates not tied to past performance.

In contrast, the other models have distinct methodologies; for instance, capitation involves a predetermined payment for patient care that is not based on historical data for individual services but rather on the number of patients. Prospective fee schedules are predetermined rates established before services are performed, and RBRVS assigns values based on the resources used to provide specific services, without direct reliance on past payment data. Thus, while each payment model has its own unique attributes, the discounted fee-for-service specifically leverages historical data for its calculations.