The “patient is always right” model has been the primary driving force behind healthcare for the last several decades. But is this the right approach? Classifying patients as “customers” is a slippery slope. While you might be able to barter with a customer at a shop about the price of a necklace, should doctors ever barter with a patient about their treatment? What about when their patient satisfaction scores are drooping low?
As Obamacare policies have gone into effect, more and more people are realizing their quality of care has been sacrificed. They are unable to schedule an appointment with their doctor, and their insurance covers little of what it used to. Unfortunately, the Affordable Health Care Act could have used more work before going into effect, and both the doctors and patients are suffering. As people and government officials are beginning to realize, the solution to healthcare cannot be fitted with a one size fits all package. As a result, direct primary healthcare (private healthcare) and concierge medicine is growing in popularity amongst both physicians and patients. Here are three reasons why.
Physician practices may be lagging behind hospitals when it comes to implementing coding software. The hesitation to do so is costing them not only efficiency in coding, but reimbursements withheld due to avoidable errors.
Summary: The healthcare industry is transforming from fee-for-service to value-based payment systems. One of the fairly new forms of reimbursement to hit the streets is bundled payments. Overview of Bundled Payments The Medicare reimbursement system is in the process of transforming healthcare as we know it from a traditional fee-for-service model to a system that rewards based on quality, care coordination, accountability, and healthcare cost savings.
The term “Big Data” has only recently entered the healthcare and medicine verbiage. It used to be largely reserved for the larger-than-life scientific research that spanned the entirety of the universe. It’s no surprise that the concept of Big Data has translated nicely to the universe inside of us.
ICD-10 was delayed once again as part of a bill that was meant to fix the physician reimbursement issues with Medicare. The ICD-1o delay was merely a footnote in a jam-packed bill that was going to make many doctors very happy; incidentally, pushing out the date for ICD-10 implementation also pleases many physicians. Some have gone so far as to say, on record, that ICD-10 lacks clinical value.
Summary: Do you understand Relative Value Units (RVUs) as they relate to Medicare reimbursement? Is your physician compensation model based upon RVUs or a derivative thereof? What is an RVU? RVU stands for Relative Value Unit and is currently used by Medicare to determine the amount of reimbursement to providers. RVUs are basically a way of standardizing and comparing service volumes across all continuums.
Summary: CMS has reversed its original proposal to cutback Medicare Advantage plan reimbursement for 2015. The reversal is a result of aggressive lobbying from organizations such as the American Medical Association. What is Medicare Advantage? According to www.medicare.gov, a Medicare Advantage plan is “a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.”
9 million Americans are covered by both Medicare and Medicaid and are part of a unique community of healthcare consumers known as the dual eligible. Dual eligible beneficiaries often have complex health conditions and may be low income, meaning that their access to healthcare would be greatly limited if not for their dual eligibility for coverage.
As a result of the Affordable Care Act as well as other healthcare legislation, a shift is occurring in healthcare from the provider's perspective. In order just to survive (not even prosper), physicians are changing the way they conduct business and choosing which patients will be seen. Shifting Landscape and Mindset - Changes in Medicare •Medicare reimbursement is certainly on the forefront. Reductions, even if 1% or less, can drastically affect a provider's bottom line. Consequently, some providers are limiting the number of Medicare patients seen by their practice. Some providers have completely eliminated access to these patients.