No more than 2 years ago, Forbes did a write-up about healthcare and why the fee for service style healthcare was going to go the way of the dinosaur shortly. Yet, two years later, it hasn’t. In the U.S. today, doctors and other providers may still be paid for every service they offer, whether or not that service is or was helpful to their client. Most defend that system by saying that doctors try to do what is best for their clients and to a point it is true.
Still, no one is arguing that fee for services healthcare can, when there are no checks and balances, be one of the more heinous types of medicine and—in some cases—is an “elaborate incentive program” for poor healthcare. The Catalyst for Payment Reform or CPR helped to explain to the world what kind of alternatives were out there for the fee for service –offering the idea of value based care or paying a little more for care that is more beneficial to the patient as opposed to paying for care that doesn’t help them.
The movement is still in its infancy even today, although it does seem to be accelerating somewhat.
Obamacare, for all its controversy, incorporates a measure of value oriented methods, changing the rules for how Medicare will pay some of the bills to acute care facilities. For example, hospitals that fail to lower the readmission rates or the infection rate will lose about 2 and a half percent of the rate that Medicare pays. Bundled payments also fall under the value methodology, so that providers will give one rate for each condition, not charge for each separate treatment or test that must be undertaken to treat the condition.
A great example of this is Geisinger Health—a company that offers one price for every kind of service that is connected to a heart surgery. What’s more, they even offer a warranty on it.
It all sounds so positive, doesn’t it? Why then isn’t value based care the rule today?
Is Value Based Care Rising?
There is some very good news. Value based care is rising rapidly, with more than 50 % of every dollar in healthcare today being used in value based care. That’s up from 11 cents on the dollar just 3 years ago.
There is, as in everything, also some bad news.
No one is sure that it’s making any real difference just yet. At least that was the case in 2015 and 2016, when it was reported that “Value-oriented payment only succeeds if we improve quality and safety,” said Andréa Caballero one of the study leaders in the 2015 report. In addition, Equity Healthcare CEO Dr Bob Galvin commented, “It’s time to measure the value of value.” Not every one—including physicians and patients, agree that value based care is the best option. Some of it is based on their personal experience and beliefs, while some of their reticence may be based in political ideology. The ACA –what many see as a starting point for value based care–was not always affordable and not always helpful. For that reason alone it does have its detractors.
Health Affairs calls value based care the “rock that got thrown into the healthcare pond.” Many physicians and surgeons feel there is no need for it. They agree that there was the odd bad apple but believe that most providers truly sought to do what was best for their patients and this system is not something in which they are fully engaged.
No one argues that value based healthcare is probably here to stay, but is it really a value? That seems to be the million dollar question that both patients and healthcare providers want to have answered—and answered to their satisfaction. Ask a lay person to define value based care or what it will do for them and most can’t. If they can’t define it and they don’t understand it, the odds are good that they aren’t engaged in it and that will be the first problem in the changeover from volume to value.
The second and more immediate issue may be political in nature. As President Trump enters office and there is the real change that the Affordable Care Act may be repealed—at least in part, there is an uncertainty in the future outlook of healthcare. No matter how you slice it, value based healthcare will have challenges to face and we can all be on the lookout for vast change in the healthcare industry this year.
Mitch Robbins is an expert as it relates to Interim and Direct Hire Nursing Leadership Recruitment for hospitals and clinics, helping organizations build best in class clinical leadership teams in the USA.
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