Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid


Are Specialists Happy with Value-Based Reimbursement?

By Ryan Mcaskill

The switch to value-based reimbursement does not have every doctor excited for change.

- Value-based care is quickly becoming one of the hottest topics in the healthcare landscape. The idea is being pushed in several different ways. The Department of Health and Human Services has, for the first time, announced guidelines and a timetable for an increased shift away from fee-for-service payments. The Affordable Care Act is increasing the incentives for quality over quantity and new technology is arriving that helps increase the ability to achieve that.

While many healthcare organizations are getting onboard the value-based approach, there is not universal acceptance that this is the best way to go. However, with the way reimbursement and federal incentive programs are going, physicians that are on the fence will have to make the switch whether they want to or not.

According to an article from the Bloomberg News, many specialists and small practices are concerned that there could be problems, especially in rural areas. The Physician Foundation found that in 2014 only 35 percent of physicians described themselves as “independent,” which is form from 62 percent, which was found in the same survey from 2008.

Bruce Signsbee, a neurologist from Rockport, Maine, who is part of a hospital system, and the former president of the American Academy of Neurology, told the news source that coordinated care and value-based reimbursement are not only ending fee-for-service, but hurting smaller practices.

“You’re really losing ready access in many parts of the country that are rural,” said Sigsbee. “There does seem to be a perceived push for people to leave independent practice by these policies.”

Jeffery Ward, a cancer doctor who left private practice for one of Seattle’s largest hospital chains, said value-based care could cause patients to bypass services like chemotherapy because they are costly.

“Fee-for-service is on its way to extinction. Bundling will hasten it,” Ward said. “Whether that’s a good thing or a bad thing is in the eye of the beholder.”

While hospitals are quicker to make the jump value-based reimbursement, specialists are moving much slower. This is because many specialists make most of their income through the fee-for-service approach. Without running tests and special services, an oncologist or neurologist will have trouble making money.

A hospital, on the other hand, can take advantage of new compensation to make up for whatever is lost by changing payment platforms just by keeping patients healthy. Specialists are mainly left out of the value-based approach.

The U.S. Centers for Medicare and Medicaid Services have been running plans to start with oncologists that have specific payment plans for them. This would mostly happen through the use bundle payments. Specialists are also looking to increase revenue by joining forces and creating larger practices.

As value-based approaches evolve, it should only be a matter of time before specialists are taken more into the fold and have a specific way to take advantage.



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