Sunday, March 29, 2015
Doctors Needing Assistance Transferring from Fee for Service to Quality of Care Reimbursement
Doctors face tremendous hurdles attempting to convert a volume based, procedural fee system to the proposed method of quality and outcome based reimbursement. Physicians and consultants alike have long recognized the inflationary component of the old fee for service methods. What is not apparent in the new proposal is that it does not discard billing for procedures, but adds on a new algorithm which modifies the fee based upon other measures, currently in development. Much of the algorithm is still in development. The calculus depends upon big data analytics measuring outcomes and some vague measures of quality.
Some have been proposed, such as hospital readmission rates, length of stay measures and others. CMS' meaningful use criteria will play a role as a built in component of certified electronic health records. Some of these tools will not be available until 2018. The initial metrics proposed for healthcare are new and arbitrary, and have not yet been proven scientifically. There are agencies such as AHRQ who have formulated guidelines, long before changes in reimbursement methodology were proposed. Quaity issues must be a thing unto itself, unbound from payment methodology. Basing payment on quality of care remains a new algorithm.