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NursingDiscussion postHealthcare finance

DNP 840 Topic 2 DQ 1: health care payment structures

The question that carries the marks is the last one: a single problem running through all three. That is a synthesis, and it cannot be reached by describing each structure in turn.

Editorial process

Last reviewed · August 15, 2026

01

Three structures, and where the risk sits in each

Name three structures that genuinely differ in where financial risk sits, because risk placement is what makes them different and it is the axis the rest of the answer runs on. Fee-for-service pays per unit of activity, so the payer carries volume risk and the provider has an incentive to do more. Capitation pays a fixed amount per person per period, moving risk onto the provider and creating the opposite incentive. Prospective or bundled payment pays a set amount for an episode, so the provider carries the risk of that episode costing more than expected while volume of episodes still pays. Value-based arrangements layer quality measures on top of one of these rather than replacing them, which is worth saying because they are often described as a fourth structure when they are a modifier. Across the care continuum also asks you to look past the hospital: post-acute, home health and hospice are each paid differently again.

The similarities and differences fall out of that framing easily. The last question is the one to spend time on: a single problem that transverses all three. Several candidates work. Every structure creates an incentive that diverges from what the patient needs, and merely changes the direction — overuse under fee-for-service, underuse and patient selection under capitation, and under bundles, shifting cost outside the bundle's boundary. All three depend on coding and documentation to determine payment, which makes the record a financial instrument as well as a clinical one and distorts what gets written. And none of them pays for the coordination work between episodes, which is precisely where a doctorally prepared nurse's contribution sits and precisely why it is hard to fund. Pick one, argue it across all three structures, and the post has the synthesis the prompt asked for. Test your candidate against the structure whose incentive points the other way.

Likely learning objectives

Inferred from the brief — check these against your own rubric.

  • 01
    Distinguish payment structures by where financial risk sits.
  • 02
    Predict the behavioural incentive each structure creates.
  • 03
    Distinguish a payment structure from a quality modifier layered on one.
  • 04
    Synthesise a problem common to structures with opposing incentives.
Assignment instructionsQuoted verbatim

Read the full question

Review every instruction before using the planning guidance that follows.

What are three payment structures used in the health care industry across the care continuum? How are they similar? How are they different? Is there a single problem that transverses all three of the identified payment structures? Explain.
Course-wide instructions that accompany this question

Important information for writing discussion questions and participation 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 Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points. Here are some helpful links Student paper example Citing Sources The Writing Center is a great resource Welcome to class DNP 840 Topic 2 DQ 1 What are three payment structures used in the health care industry across the care continuum Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot 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 should 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. 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! Name: Discussion Rubric Grid View List View Excellent 90–100 Good 80–89 Fair 70–79 Poor 0–69 Main Posting: Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. 40 (40%) – 44 (44%) Thoroughly responds to the Discussion question(s). Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. No less than 75% of post has exceptional depth and breadth. Supported by at least three current credible sources. 35 (35%) – 39 (39%) Responds to most of the Discussion question(s). Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 50% of the post has exceptional depth and breadth. Supported by at least three credible references. 31 (31%) – 34 (34%) Responds to some of the Discussion question(s). One to two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Cited with fewer than two credible references. 0 (0%) – 30 (30%) Does not respond to the Discussion question(s). Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible references. Main Posting: Writing 6 (6%) – 6 (6%) Written clearly and concisely. Contains no grammatical or spelling errors. Adheres to current APA manual writing rules and style. 5 (5%) – 5 (5%) Written concisely. May contain one to two grammatical or spelling errors. Adheres to current APA manual writing rules and style. 4 (4%) – 4 (4%) Written somewhat concisely. May contain more than two spelling or grammatical errors. Contains some APA formatting errors. 0 (0%) – 3 (3%) Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style. Main Posting: Timely and full participation 9 (9%) – 10 (10%) Meets requirements for timely, full, and active participation. Posts main Discussion by due date. 8 (8%) – 8 (8%) Meets requirements for full participation. Posts main Discussion by due date. 7 (7%) – 7 (7%) Posts main Discussion by due date. 0 (0%) – 6 (6%) Does not meet requirements for full participation. Does not post main Discussion by due date. First Response: Post to colleague’s main post that is reflective and justified with credible sources. 9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. 8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting. 7 (7%) – 7 (7%) Response is on topic and may have some depth. 0 (0%) – 6 (6%) Response may not be on topic and lacks depth. First Response: Writing 6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. 5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. 4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. 0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. First Response: Timely and full participation 5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date. 4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date. 3 (3%) – 3 (3%) Posts by due date. 0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date. Second Response: Post to colleague’s main post that is reflective and justified with credible sources. 9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. 8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting. 7 (7%) – 7 (7%) Response is on topic and may have some depth. 0 (0%) – 6 (6%) Response may not be on topic and lacks depth. Second Response: Writing 6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. 5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. 4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. 0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. Second Response: Timely and full participation 5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date. 4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date. 3 (3%) – 3 (3%) Posts by due date. 0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date. Total Points: 100 Name: Discussion Rubric

02

Turn the brief into deliverables

  1. 01
    Three structures with the risk-bearer named for each.
  2. 02
    The incentive each creates.
  3. 03
    Similarities and differences drawn on a stated axis.
  4. 04
    One problem argued across all three.
03

Describe, compare, then find the shared problem

01

Three structures and their risk

Describe each structure by who bears financial risk.

02

The incentives each creates

Predict provider behaviour from the payment design.

03

Similar and different

Compare the three on a consistent axis.

04

The problem running through all three

Argue one shared failure across structures with opposing incentives.

04

Where each structure is defined in the rules

Recommended databases

  • CMS payment programme pages
  • KFF
  • PubMed Central
  • MedPAC reports

Search sequence

  1. 1.
    Confirm how each structure is defined by the payer rather than in general terms.
  2. 2.
    Find evidence of the behavioural response each structure produced.
  3. 3.
    Look for research on coding intensity as a response to payment design.
  4. 4.
    Check whether care coordination is reimbursable under any of the three.
05

Reference shortlist

These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.

Nothing here is cleared for citation until you have read it.

  1. 01

    Value-Based Programs

    Centers for Medicare & Medicaid Services · 2025

    Sets out the value-based programmes as modifiers layered on existing payment, which is the distinction most posts get wrong.

  2. 02

    Pay-for-Performance and Value-Based Care

    StatPearls, NCBI Bookshelf · 2024

    Covers pay-for-performance and value-based care, including the incentives each design produces.

  3. 03

    DRG payment, financial signals, and low-value hospitalizations

    Frontiers in Public Health · 2026

    On DRG payment and the financial signals it sends, which is the coding-as-financial-instrument problem in evidence.

  4. 04

    BPCI Advanced

    Centers for Medicare & Medicaid Services · 2024

    A live bundled-payment model, showing where episode boundaries fall and what sits outside them.

06

Review before submission

Common mistakes

  • Listing value-based purchasing as a fourth structure rather than a modifier.
  • Describing the structures without naming who bears the risk.
  • Answering the transverse-problem question with a general complaint about cost.
  • Treating the three separately and never synthesising.

Submission checklist

  • Is the risk-bearer identified for each structure?
  • Does each structure have a predicted incentive?
  • Does your transverse problem genuinely apply to all three?
  • Are similarities and differences drawn on the same axis?

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Argumentation and thesis development

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