Shifting Away From Fee-For-Service: Alternative Approaches to Payment in Gastroenterology.
نویسندگان
چکیده
Fee-for-service payments encourage high-volume services rather than high-quality care. Alternative payment models (APMs) aim to realign financing to support high-value services. The 2 main components of gastroenterologic care, procedures and chronic care management, call for a range of APMs. The first step for gastroenterologists is to identify the most important conditions and opportunities to improve care and reduce waste that do not require financial support. We describe examples of delivery reforms and emerging APMs to accomplish these care improvements. A bundled payment for an episode of care, in which a provider is given a lump sum payment to cover the cost of services provided during the defined episode, can support better care for a discrete procedure such as a colonoscopy. Improved management of chronic conditions can be supported through a per-member, per-month (PMPM) payment to offer extended services and care coordination. For complex chronic conditions such as inflammatory bowel disease, in which the gastroenterologist is the principal care coordinator, the PMPM payment could be given to a gastroenterology medical home. For conditions in which the gastroenterologist acts primarily as a consultant for primary care, such as noncomplex gastroesophageal reflux or hepatitis C, a PMPM payment can support effective care coordination in a medical neighborhood delivery model. Each APM can be supplemented with a shared savings component. Gastroenterologists must engage with and be early leaders of these redesign discussions to be prepared for a time when APMs may be more prevalent and no longer voluntary.
منابع مشابه
Two Wrongs Do Not Make a Right: Flaws in Alternatives to Fee-for-Service Payment Plans Do Not Mean Fee-for-Service Is a Good Solution to Rising Prices; Comment on “Fee-for-Service Payment - An Evil Practice That Must Be Stamped Out?”
Professor Naoki Ikegami’s “Fee-for-service payment – an evil practice that must be stamped out” summarizes many of the failings of alternatives to fee-for-service (FFS) payment systems. His article also offers several suggestions for improving FFS systems. However, even powerful arguments against many of the alternatives to FFS, does not make a convincing argument for FFS systems. In addition, ...
متن کاملFee-for-Service Payment – An Evil Practice that Must be Stamped Out?
Co-opting physicians to regulate Fee-for-Service (FFS) payment is more feasible and simpler to administer than capitation, Diagnosis-Related Groups (DRGs) and pay-for-performance. The key lies in designing and revising the fee schedule, which not only defines and sets the fee for each item, but also the conditions of billing. Adherence to these regulations must be strictly audited in order to c...
متن کاملارزیابی شیوه های تامین مالی و نظام پرداخت به ارائه کنندگان خدمات سلامت در کشورهای منتخب: ارائه ی الگو برای ایران.
Introduction: Majority of health systems across the world are experiencing challenges in their performance, quality, equity, and efficacy because financial resources limitation. To deal with, they use different method of financial allocation resources and payment systems. Methods: This comparative descriptive research is dedicated to financing methods and payment systems to the health service p...
متن کاملHealthcare Reimbursement and Quality Improvement: Integration Using the Electronic Medical Record; Comment on “Fee-for-service Payment - an Evil Practice That Must Be Stamped Out?”
Reimbursement for healthcare has utilized a variety of payment mechanisms with varying degrees of effectiveness. Whether these mechanisms are used singly or in combination, it is imperative that the resulting systems remunerate on the basis of the quantity, complexity, and quality of care provided. Expanding the role of the electronic medical record (EMR) to monitor provider practice, patient r...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
دوره 14 4 شماره
صفحات -
تاریخ انتشار 2016