Request a Live Demo

Please take a minute to tell us about yourself

* All fields required

View our Privacy Policy  or  Terms and Conditions.

Submit

Thanks! We'll be in touch soon!

In the meantime, please feel free to give us a call at 800.981.5084, explore the site or check out a video.

An error occured

Please feel free to give us a call at 800.981.5084

close
Request demo Call athenahealth Menu
hero

Practice management knowledge hub

Is your practice running as efficiently as possible? Discover tips and insights that can help streamline your practice management.

Healthcare payment reform

No one quite knows what the ultimate result of healthcare payment reform will be, but it seems clear that the industry will gradually move away from the long-dominant fee-for-service model. Rather than motivating and encouraging care coordination, patient engagement and quality, the fee-for-service model rewards volume. As a result, there is no market for a combination of quality outcomes and cost-effective health care – only one that pays for tests and procedures.

Unless the market shifts, costs for medical services will continue to rise and, as they do, it’s expected that payers, employers and patients will pay higher prices for less.

While government initiatives such as the Physician Quality Reporting System (PQRS) and the Meaningful Use program are a step in the right direction, quality is only one variable in the health reform equation. Cost control and outcomes measurement are notably missing from these penalty- or bonus-based programs.

However, the introduction of the Accountable Care Organization (ACO) model marks the next step in the evolution of health care payment reform and government reimbursement. The ACO model includes a risk basis for payment, and a focus on population health and care coordination that brings the industry closer to value-based payment.

In addition, over the next few years, the CMS Innovation Center will introduce a number of other health care payment reforms, such as bundled payment, pay-for-performance pilot programs and reduced Medicare payments for physicians not participating in PQRS.

Private payers are also highly motivated to cut health care costs because they are responsible for treatment costs not covered by government programs or paid for directly by patients. They are attempting a variety of health care payment reforms, none of which are likely to emerge as the dominant model but which serve, nevertheless, as steps along the way to the ultimate shape of payment reform.

For example, more than 25 health plans now incorporate Patient-Centered Medical Home (PCMH) recognition into their own programs, and many will offer financial incentives to practices that adopt the medical home model.

The industry is experiencing only the tip of the iceberg today. Ultimately, health care payment reform may change how medical services are administered and reimbursed in ways that will impact every practice in the nation.

Online Demo

Practice Management & Medical Billing
Whitepaper Icon
See how athenaCollector can streamline the workflow at your practice.

Whitepaper

Navigating Payment Reform, Thriving through Changes to Come
Whitepaper Icon
Learn how to help your practice succeed through payment reform.

From our CloudView Blog

CMS’ Value-Modifier 2018: Where is the transparency?
Whitepaper Icon
We made it through the holidays and came out on the other end ready to kick off an exciting 2017, but providers particip...