FPGEE for National Association of Boards of Pharmacy (NABP) Practice Exam

What does the term "churning" refer to in the fee-for-service system?

1. Providing required services

2. Billing without patient consent

3. Exceeding necessary service frequency for profit

4. Bundling similar services

The correct answer is: Exceeding necessary service frequency for profit

Churning in the fee-for-service system specifically refers to the practice of exceeding the necessary frequency of services provided to a patient, primarily for the purpose of generating additional revenue. This behavior typically involves healthcare providers conducting more tests, procedures, or services than are medically necessary, leading to an increase in healthcare costs without a corresponding benefit to the patient’s health. It raises ethical concerns and can contribute to a deterioration of trust in healthcare systems, as patients may receive inappropriate or excessive treatments. The context behind this term is rooted in the nature of the fee-for-service model, where providers are reimbursed for each individual service rendered. This model can create an incentive for providers to maximize the volume of care delivered, regardless of its clinical necessity. Awareness of churning is vital for pharmacists and healthcare professionals as it underscores the importance of providing care that prioritizes patient health outcomes over financial gain.