Hospitals, clinics, and physicians are seeking ways to maintain a level of their accepted and accustomed reimbursement while facing new payment contracts. It has been and will continue to be a major struggle.
Where health care providers once received payments for the number of patients seen and the quantity of tests ordered (e.g. laboratory, imaging, and physical therapy), known as fee-for-service, now their payments are based upon the quality of care they administer to their patients, that is value-based care.
The initiative behind value-based care is to provide higher quality care at a lower cost. Lowering costs while improving the quality of care is certainly praiseworthy, but like most endeavors, there is a trade-off. Those healthcare systems and clinicians that are unable to meet the quality requirements will face monetary fines and lower reimbursements. Compounding the problem too is that providers are facing decreasing payments by commercial insurance while increasing Medicare and Medicaid payers that have considerably lower payment rates.
Health Systems face one of the greatest challenges to their bottom line. It is gargantuan. There is no way that one can cover value-based care in a three hundred word blog. I will make note of my observations and my concerns.
Value-based reimbursements, the incentives, and penalties are dependent on quality measures. Providers now need manpower to do reporting that requires comprehensive and refined analytical software. The purpose of having superior reporting and analytical software is so that hospital leaders may determine and discover what is occurring at their hospitals before it is too late to do anything.
What is happening is that small hospitals cannot afford the software or free up manpower to do the essential reporting and analysis. Quality scores suffer, reimbursements decrease, reputation then suffers, and ultimately they lose patient count. It is a woeful death spiral. Sadly, hospital executives begin to layoff employees, decrease services, and take away employee benefits and perks.
What is even worse, fudging of numbers, erroneous reporting or even lack of reporting is happening. Surely not what the government intended; again, the purpose is to improve quality and lessen the cost.
Healthcare leaders need to find ways to improve their quality and costs as intended, and not ways to attempt to “beat the system.”