Discussing the Switch to Value-based Reimbursements
Value-based Reimbursements is being talked about in almost every corner of the healthcare industry today. It brings about a huge wave of change that most healthcare practitioners are still getting a hang of. This is the case because the essence of Value-based Reimbursements requires a switch from the original more familiar mode of reimbursements (fee for service) to value-based.
This switch to value-based reimbursement turned the traditional model of healthcare reimbursement on its head, causing providers to change the way they bill for care and track their billings and payments. Instead of being paid by the number of visits and tests they order (fee-for-service), providers’ payments are now based on the value of care they deliver (value-based care). And while the industry waits for the final policy from the federal government, one thing is certain—the trend for value-based care models will continue.
Much of this change is long overdue and quite exciting because it’s driving improvements to the delivery of care by mandating better care at a lower cost. But for providers and health systems that can’t achieve the required scores, the financial penalties and lower reimbursements create a significant financial burden. There is also the aspect of the unavoidable drop in efficiency and production of services due to this switch. Even if the switch will be for the better in the long run, the negative effects this changes and confusion are causing should not be ignored.
There was a report put together by a group of experts that covers the topic of value based reimbursements. This report tries to cover an doubts and questions while exploring the possibilities this change from fee for service to value based could bring. The report is summarized below--
- The conversion of the healthcare industry from pay-for-volume to pay-for-value isn’t going to be easy or pretty, and it won’t happen until providers decide they have to assume risk, Wennberg says. “That’s the chicken-or-egg issue people will have to figure out from a policy standpoint. It’s just a lot easier to do what you’ve always done and made money at it than to take a risk if you don’t have to.”
- A certain amount of scale is required for success. Whether an ACO is hospital-led or physician-led, it needs deep pockets to build the necessary infrastructure and hire sufficient care managers.
- Providers will have to become accustomed to the idea of delivering high-quality care within a budget.
The report did not just identify the problems, it also provided the following twelve recommendations to consider in making the transition to value-based reimbursement:
- Make sure you have enough primary care physicians and other clinicians to provide comprehensive preventive and chronic care
- Restructure physician comp to align provider incentives with value-based care
- Create patient-centered medical homes or use existing PCMHs as building blocks for your ACO
- Focus on care management for high-risk patients as well as other segments of the population that could become high risk in the future
- Automate as much of population health management as you can while emphasizing human contact for high-risk patients
- Embed care managers in practices wherever possible to create close relationships with patients
- Don’t try to manage population health with your EHR alone, but use applications built for population health to help accomplish your goals
- Integrate claims data with clinical data to provide breadth, timeliness, and adequate detail for analytic purposes
- Find ways to obtain timely information from hospitals and health plans about admissions, discharges, and procedures
- Use predictive modeling to intervene with patients who are likely to get sick in the coming year
- Use registries to track patients’ health status and make sure they get the services they need
- Apply financial analytics to budgeting, using historical data on costs and, if possible, activity-based cost accounting.