Healthcare payment reform on the march
Tuesday, March 22, 2016
Controlling healthcare spending might start with the data generated through healthcare claims. So far, collecting that data in the claims has been called a headache, but harnessing it may be the key to developing alternative payment models.
"Current resource use measurement and payment systems use complex episode groupers, statistical attribution methodologies and risk adjustment systems to try and extract information from claims data that it was not designed to provide," the Center for Healthcare Quality & Payment Reform points out.
Until now, payment reform methodologies have created weaknesses that "have the potential to harm patients and healthcare providers, particularly small physician practices and hospitals." That may be about to change, as new payment and delivery models in development may be the key to improving efficiency and controlling costs, a new report from Fidelity Investments and the National Business Group on Health suggests.
But let's not get too excited. Physicians in the report are only "cautiously" optimistic that new payment models may contribute to a higher quality of care and improved patient outcomes. As we know, anything so complex and contentious as payment reform is not likely going to be fixed or moved significantly in the short term.
In fact, the Center points out: "Despite widespread agreement on the need for major improvements in healthcare payment systems, progress in implementing truly meaningful payment reforms has been frustratingly slow."
New payment models tie reimbursement to quality and performance outcomes, as most of the current headlines point out. For example, Medicare hopes to have 85 percent of the program's hospital pay broadly tied to quality by 2017.
This is good news for physicians, who don't think the current fee-for-service model is "aligned with providing high-quality healthcare." As many as 40 percent say pay-for-performance is the optimal care delivery method. And the younger the physician, the more these sentiments are shared.
It's not a surprise, given that pay-for-performance has been the adage of tomorrow for several years.
"Physician buy-in and support are crucial to the success of these new delivery models," Brian Marcotte, president and CEO of the National Business Group on Health, said in a statement. "We are asking physicians to change how they engage their patients, manage their practice and get paid. The right resources, technology and analytics have to be in place to help physicians make this transition to deliver on the promise of improved patient outcomes and lower costs."
Other payment systems may deliver a variety of positive benefits, including improved quality of patient care, greater efficiency of medical practices and improvements in overall patient health. When asked to rate the top benefit of alternate payment models on their practice, physicians ranked "positive impact on patient health" as the top-rated outcome.
According to the Health Affairs Blog, other rising health payment reforms loom in the future — including Medicare Access and CHIP Reauthorization Act (MACRA) enacted in 2015 to replace the Sustainable Growth Rate (SGR) for physician payment. Also receiving much attention for payment are telehealth services and how these services are to be reimbursed, but much talk has brought little action.
Some suggest that before payment reform can truly take place, the healthcare industry needs to fix three signature pay-for-performance programs: the Value- Based Purchasing Program (VBP), the Hospital Readmissions Reduction Program (HRR) and the Hospital-Acquired Condition Reduction Program (HAC).
To make sure these programs are working efficiently, Medicare should use their early experience to integrate them, Healthcare Finance reports.
However, despite the warm feelings by many toward pay-for-performance, a separate Rand report focusing almost solely on pay-for-performance models affecting physicians showed that these professionals expressed uncertainty about optimal payment methods and focused on the headaches of implementation of the payment model. Researchers suggested that physicians lacked support and were burdened by administrative details and too many quality benchmarks.
Despite the encouraging news from the National Business Group on Health, much work still must be done.
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