Ensuring the Values in Value-Based Payments.

More than a century after Twain wrote his comments, what we now label “fee-for-service” has, as Twain lamented, continued as the dominant payment model in health care. However, the march toward value-based payment has started to change the system, and far more dramatic changes are on the horizon. The Affordable Care Act and payment reform are transforming the system back to Twain’s “old time custom” of paying the physician based on a budget. The shift has opened up vast potential for the health system to move toward a preventive ethos while at the same time establishing a new area of ethical scrutiny that impacts patient care. Value-based payment creates new ethical challenges and requires new skill sets of ethicists and mission leaders to ensure we preserve our values as we move toward value-based payment models.