Cablayan LNHA, MHA

Healthcare Systems

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The New Face of Medicare Reimbursement

February 25, 2015Erwin Cablayan0 Comments

“Doctors and hospitals will have to be paid differently. Not simply for procedures—the more they do the more they make—but for outcomes,” – Dr. Tim Johnson explained on ABC News.

Outcome-based, performance-based, results based, value based – these different terms have slightly different implications but all convey a similar message: that providers will receive payment based upon the outcome of care. At issue here is whether or not incentive-based initiatives improve the quality and overall quality of our health care.

Health reform legislation has offered the promise of dramatically altering the way providers are paid, changing from paying for volume to paying for value. But, in doing so, are we sacrificing the quality of care?

Performance-based regulations rely on quality measures that may fall in four general categories. Process measures, outcome measures, patient experience measures, and technology.The effects of all four categories influences pay for performance programs. Of the four, the most subjective measurement will be patient experience. It simply relies on the perception of the quality of care received and the patient’s satisfaction with the care. While it is difficult to argue against process or outcome measures of care, it can present an environment amongst healthcare providers to promote an assembly-line effect in an effort to generate revenues.

The amount of red tape and government regulations could compromise the doctor-patient relationship. While pay for performance encourages the identification of proven practices using evidence-based medicine, it begs the question: Will these policies increase pressures on an already high-pressured profession?