Administration starts chipping away at fee-for-service healthcare system by Joan McCarterFollow Doctors and nurses show Under Secretary of the Army Joseph W. Westphal their new remote control da Vinci Surgical System, which enables surgeons to perform operations through tiny incisions and is powered by high-tech robotics that gives the surgeon the best possible view with HD cameras at the Fort Belvoir Community Hospital, May 30, 2012, at Fort Belvoir, Va. The way doctors get paid in the United States is by providing services. The way doctors get paid even more is by providing even more services, sometimes unnecessary ones. In fact, the Institute of Medicine has estimated that Americans spend $210 billion annually on unnecessary health care. Its a key factor driving the increase in healthcare costs. Its not just greed on the part of physicians and hospitals—often theyve invested in very expensive equipment, like MRI machines, and want to use them to get a return on that investment. They have all these tools at their disposal for providing health care, and want to use them. But often, they dont need to. Now, theyll be incentivized not to, if the latest reform effort by the Obama administration works. The Obama administration announced Monday a sweeping new plan that will directly affect thousands of hospitals and doctors across the country. The federal government now plans to pay Medicare doctors more if they help patients get healthier—and less if their patients just stay sick. This would be done by tying 85 percent of all Medicare payments to outcomes by the end of 2016—rising to 90 percent by 2018. […] Todays announcement is, in some ways, the big change that some health care experts pleaded for in 2010. Its the first time the federal government has set a specific goal for moving towards a health care system that rewards value. Its a really big deal for the largest insurer in the United States to signal to hospitals and doctors that it intends to move aggressively in this direction, says Chas Roades, chief research officer at the Advisory Board, a hospital consulting firm. A number of smaller Medicare reforms have been put in place since Obamacare was signed into law, and theyve helped profoundly reduce the rate of spending growth in that program in the last several years. Theyve made hospitals safer and reduced readmissions by penalizing providers if they mess up the first time and the patient has to go back to the hospital. Accountable Care Organizations (ACO) have been created to provide more systematic and coordinated care, rewarding groups of doctors for providing appropriate care. These kinds of things have made a difference and have helped hold down Medicare spending, but have been largely at the margins. This new initiative changes that, going right to the heart of the fee-for-service problem, focusing on outcomes rather than services, health care instead of sick care. Many private payers—insurance companies—follow Medicares lead on payment systems, particularly when what Medicare is doing ends up saving money.
Posted on: Tue, 27 Jan 2015 10:29:27 +0000