The Forbes article noted “If you didn’t know it, the key intent of Affordable Care Act is to shift medical care from fee-for-service to fee-for-quality.”
“For too long, hospitals have gorged on referrals into their systems and walk-ins to their emergency rooms. But besides electronic medical records—a low hanging fruit–hospitals are hailed widely as being inefficient and sloppy. But the game changes when hospitals start getting paid for how many people they heal, not how many people they process. Think: outcomes not transactions.”
“Speak to anyone in the industry and not a conversation goes by without the mention of risk. Right now there is a fundamental healthcare shift in who bears risk. Much of this risk is shifting from health insurance companies to health providers. Cutting out the middleman. Approximately 60% of Americans are covered by employer-provided health insurance or self-insured companies. These employers are craving not only pricing transparency but also pricing predictability and stability. Why shouldn’t hospitals cut out the insurance middleman and start contracting direct to employers that are controlling such a large amount of spending.”
“To this end, hospitals can offer bundle payments for a procedure where employers know what they’re paying for procedure X, say a hip replacement, and hospitals know the new revenue they’re generating and now have to manage to keep the costs down for the total transaction in order to make a return.”
Click here to read the full Forbes article “Life Or Death For Hospitals” by Josh Wolfe.
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Doctor, Did You Wash Your Hands? ™ provides information to consumers on understanding, managing and navigating health care options.
Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration.
This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.