Health care costs in the United States are out of control, and many have criticized the Patient Protection and Affordable Care Act for not doing enough to lower them. But the Obama administration hopes to do just that by tying Medicare payments to patient outcomes. Additional legislation that’s going through Congress right now will allow greater access to Medicare and Medicaid health data, in a bid to improve quality of care and lower costs.
By the end of 2016, the Obama administration expects to tie most Medicare payments to patient outcomes, instead of to the number and extent of tests and procedures done. This means that doctors and hospitals across the nation are going to need to increase the quality of their care, or they risk losing a big portion of their Medicare payments. The demand for health care quality analysts, health care quality assurance professionals, and health care managers is on the rise.
Changes in Medicare Payments Expected to Start New Industry Trend
As of 2016, the Centers for Medicare and Medicaid Services (CMS) will tie 30 percent of Medicare and Medicaid payments to patient outcomes. By 2018, they hope to tie 50 percent of Medicare and Medicaid payments to patient outcomes. That means that soon, doctors who treat Medicare and Medicaid patients will be paid based on how well their patients do, not on how may services they can manage to charge fees for. By the end of next year, the Obama administration wants 85 percent of Medicare payments to occur under the new value-based scale.
The new fee-for-value system is expected to cut costs associated with the Medicare and Medicaid programs by making it harder for doctors to adhere to the fee-for-service model that has reigned supreme throughout the U.S. health care industry.
Soon, doctors won’t be able to simply claim line-by-line Medicare reimbursements for every test, scan, or procedure. Improving patient outcomes in this manner is also expected to lower follow-up care costs. Patients who recover well and don’t need to go back into the hospital three weeks after being released are patients who cost the system less money.
Since private insurers often follow Medicare’s lead when it comes to reimbursing physicians and hospitals, it’s hoped that both lowered cost and improved care will eventually be passed on to the privately-insured consumer. More and more health care quality assurance professionals will be needed as the fee-for-value model replaces the fee-for-service model in the United States. You can prepare to meet that need by earning an MSN in Health Care Quality.
The ACA already exacts penalties when Medicare and Medicaid patients must return to the hospital within 30 days of being discharged, and it has provisions to encourage closer collaborations between doctors, nurses, and other members of the care team. These measures make health care more efficient, and have saved an estimated $12 billion and 50,000 lives, according to the DHHS.
Medicare Data May Soon Be More Accessible
A law currently going through Congress, called the Quality Data, Quality Healthcare Act, would make it easier for insurers, doctors, and health care systems to access Medicare data. The new law would reform and modernize the Qualified Entity program, a program that allows organizations access to Medicare data. Under the QDQH Act, organizations that receive Medicare data would be allowed to analyze and then re-distribute it.
These organizations would also be able to charge subscribers’ fees to those who want access to the data, which could provide the funding necessary to perform the sort of in-depth analyses necessary to truly boost health care quality and lower health care costs.
Health care isn’t getting any cheaper in the United States, but that could soon change. The DHHS and CMS are working together, with the encouragement of the Obama administration, to tie Medicare and Medicaid reimbursements not to the number of tests and procedures a doctor performs, but to how well the patient recovers. The new fee-for-value model is expected to replace the old fee-for-service model, as private insurers follow Medicare’s lead and adopt its practices as their own. Only time will tell, however, whether this plan will successfully lower costs and improve care, or whether it will only backfire.