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Running head: HEALTHCARE PAYMENT SYSTEM

HEALTHCARE PAYMENT SYSTEM 2

Healthcare Payment System

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Healthcare Payment System

There have been trends and changes of technology in the healthcare sector over the years and this include improvement in terms of treatment practices and use of advanced equipments and instruments of care (Fattore, 2019). The advancement and trends of the healthcare technology also comes along with the changes in the payment system in order to be compatible with the existing technology. The healthcare sector has advanced over the years and the main transformation that is more evident is the online data management where the introduction of the electronic health records is used and this makes it easy during billing patients care (CapMinds, 2020).

In addition, the increasing life expectancy due to the advances of technology and clinical care has challenged the healthcare system about its ability to offer efficient and effective continuing care. There is the fact that the changes in payment structure and reform initiatives are considered the forefront of healthcare decision making. There is much emphasis that is directed towards the primary care, transitional care, bundled payment and accountable care organization are fundamental issues in the United States healthcare today (CapMinds, 2020). The payment system has undergone some changes and has contributed to several impacts to the patients and other stakeholders. The changes in the payment system have been highlighted below:

Moving to Value from Volume

The fee-for-service model has been functional till recently where the healthcare providers are encouraged to deliver high volume of care that at times might compromise on the quality of care. The volume based care is considered unreliable and might affect the quality of care delivered to the patient with the objective of attending to more patients without considering much about the outcome. In 2019 is when the move towards the value-based care was promoted (Fattore, 2019). Attention has been directed towards the payments based on the practices and patients to costs. Based on the aspect of change there is the fact that now patients that pays for care out of their pockets are there to enjoy better value for their money (CapMinds, 2020). The approach has created a kind of competition in the healthcare and those healthcare facilities that offering quality care for high prices would consider to up their game in order to deliver quality at a lower price and lower risk value for their patients.

The value based purchasing was a payment system that was introduced by the Affordable Care Act (ACA) of 2010 where the quality is now assessed through the public lens where value based payment is surrounded by the clinical process, patient experiences, structural process and utilization measure. The hospital value-based purchasing is an important part of the centers for Medicare and Medicaid services’ long standing effort to link to the Medicare Payment System to value-based system targeting on improving the healthcare quality including impatient care quality (Feldhaus & Mathauer, 2018). The focus was to eliminate the issue of the healthcare system from a payment structure that reimburses for quantity of care and replace it with the one that focuses on standards of care and best practices.

Impact of Value-Based Purchasing to Nursing Practice

“The shift to the value-based purchasing that occurred in 2016 came with the expectations that Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCHAPS) and efficiency would represent 25% and the outcomes are expected to rise to 40% and core measures account to 10%” (CapMinds, 2020). Nurses have experienced the challenge to change on ways they conduct their operations and they need to be creative and innovative by consistently looking for new ways of handling and improving care quality since the system has been fragmented. The nurses need to come up with ways where they would integrate, collaborate and coordinate care for the interest of the patient and the healthcare facility. The payment system that was introduced (value-based) by ACA offered an important opportunity to the nurses and this include playing the leadership role that is leading change in healthcare.

The opportunity was unique since the nursing profession practice has never leaded the change or reforms team and this was an appreciation being the cornerstone of healthcare transformation. There is a gap that was experienced in the payment reform and this is about lack of enough knowledge about the value-based purchasing method by the nurses making it difficult to implement it since it will disadvantage others. There is the need to push for more training about the method to promote a sound understanding about the topic and appreciate about the changes taking place in a daily practice (CapMinds, 2020). A better understanding of the payment system by the nurses promotes quality care that would have the best impact on the patient recovery rate and also an immediate response for treatment. Nurses need to understand change in healthcare including the payment system in order to position them in good position and meet their professional obligation and make sure that patients are satisfied.

Impact of Value-Based Healthcare to Patients

Value based healthcare is a healthcare delivery model that ensure that providers that is hospital or physicians are paid based on the patient health outcomes. Value based care system makes sure that the providers are rewarded based on the improvement of patient health or reduce the effects or symptoms of a chronic disease. The value-based system ensure that the patient gets an access to care first and offered the necessary treatment and emergency care before payment and that makes it unique from the fee-for-service reimbursement method (CapMinds, 2020). The value-based healthcare system has a positive impact to the patient access to care as indicated below.

Patient Spends Less for Better Outcome

The value-based healthcare system concentrates more on the provision of the preventative care which is cheaper as compared to the treatment of chronic illnesses like diabetes, obesity or hypertension that is known to burden the healthcare system in the United States (Feldhaus & Mathauer, 2018). The healthcare providers that comprise the physicians and nurses are also determined on using the best treatment methods that are likely to help the patients recover quickly from injuries and illnesses in an effective manner. A good and quick treatment minimizes the days of hospitalization that reduce the costs of care and also limited re-visits to the facility. The value-based type of payment makes the costs of care less as compared to the traditional type because there are limited doctor’s visits, medical treatments and medical procedures (CapMinds, 2020). The cost reduction is what most patients are looking for especially the low income and middle income earners since the access to healthcare is the most important thing that the population should afford to access. The access to quality healthcare at lower costs is one of the main goals that most learners are targeting.

Increased Patient Satisfaction

The value-based care model is an important payment model that pushes the healthcare providers to deliver and this would result to achieving a successful healthcare process. The fee for the service model was more of a money collective technique where the healthcare providers were committed in even conducting unnecessary tests and treatments just to make money. The value-based care has made patients feel more satisfied with the treatments that are being offered. The value-based model is driving the healthcare professionals to accomplish their expected financial targets in line with the quality treatment that result to patient satisfaction and experience (Feldhaus & Mathauer, 2018). The patients that access to the value-based healthcare experience the best quality care experience where they would come and recommend the quality care they receive. The healthcare billing technique improves patient satisfaction by having the best and simplified billing process that ensures that patients interests are put first. The value-based payment model improves patient satisfaction through creating a good relationship between the patients and the healthcare providers because the providers fear that they would not be paid if they fail to offer quality care (CapMinds, 2020). Improved communication with patients is also experienced in order to achieve the patient satisfaction that matters to the payment model where the interests and patient satisfaction is paramount.

Improved Care Coordination

The traditional model was much of a restriction to the healthcare providers where they were limited to access some of the suppliers needed to offer necessary care and treatment to patients. The value-based care is more that a motivation to the healthcare providers especially the physicians that are responsible in delivering the treatment services needed to the patients. The opportunity of the physicians to have the power to acquire the suppliers needed for treatment from different suppliers motivates them in delivering the quality care since they understand what is best for the patient. The value-based care system has incentives and improved technology that enable the providers to consider coordinating care. A good coordination comprises of teamwork and collaboration with other healthcare providers targeting on offering quality care for a positive outcome that would translate to a better pay (CapMinds, 2020). The integration that healthcare providers practice in the value-based care model promotes sharing ideas and concepts about treatment helping in improving overall health.

Reduced Healthcare Costs and Improved Care

The value-based case model is an important payment system that makes it possible in reducing the healthcare costs by making sure that the patients only pays for the relevant and best healthcare services needed. The traditional system that is fee-for-service system result to patients paying for unnecessary services that healthcare providers targets on collecting funds from the patients for their personal benefits. Most of the patients rely on the government insurance cover for care and the application of value-based model becomes a benefit to the government where the funds allocated to the healthcare sector is reduced or used for other development matters (Feldhaus & Mathauer, 2018). The reduced spending of the allocated money to the healthcare sector by the government increase the number of patients that will access to quality healthcare services through an extensive insurance cover. In a scenario where few people in the population require a costly care result to a reduced total healthcare spending that gives a financial benefits for individuals, businesses and government.

Strong Cost Control and Reduced Risk for Payers

The payers, healthcare providers and patients are the main beneficiaries of the value-based care system. The value-based care is known to lower costs across the board and this translates that the insurance firms finds it easy to pay less for the patient care specifically their subscribers. A less costs of payment by the insurance companies would translate to a lower premium rates and deductibles making healthcare services affordable to patients. In addition, the value-based payment would make it possible for the payers to increase efficiency by bundling payments that cover the patient full care cycle and also help in covering patient chronic illnesses that might not be achieved in the traditional method.

The increasing change from the traditional fee-for-service model to the value-based care CMS has concluded a long-term healthcare costs that will begin to lower the costs of care and at the same time help patients learn about living a healthier and more productive life (Feldhaus & Mathauer, 2018). The approach to help the healthcare providers in the adoption of the value-based care there is the need to integrate specialized patient-centered software system into the electronic health records (EHRs) that helps in the search and capture all appropriate conditions of the populations.

Prospective Payment System

The prospective payment system was designed mostly to incentivize the healthcare providers to consider establishing a delivery system that is likely to offer high quality patient care without the need of overtaxing the clients and the available resources. There is much unnecessary expenditure of the healthcare resources associated with the conventional fee-for-service payment system. The managed care organization play an important role in allocating risks in an effective manner and they contribute much when it comes to the allocation of risks to the payers and providers based on the type of risks they can manage. The prospective payment system works in a manner that it shifts the risk of treating a given population of patients to the provider. The payment system is pushing for the formulation of a more fair payment structure that would encourage the healthcare providers to deliver a high value healthcare to patients.

The healthcare delivery has existing rules and responsibilities that make sure that there are an alignment of risk obligation between the payer and provider and this guides on the payment methods that are employed in the process of paying for medical care. The advantage that comes with the prospective payment system is that it holds the payer and providers with a responsible with the portion of risk that can be possible managed. The prospective payment system has been confirmed to be the most preferred risk management strategy in the healthcare when it comes to payment for services. The prospective payment system is characterized by code-based reimbursements that create an incentive that is more accurate in coding and billing. The application of the EHRs system is an important technology that would help in capturing the needed risk category code that makes it possible to make the necessary reimbursements.

Online Payment Systems

Technology advancement in the healthcare sector has influenced more aspects including the payment methods and the trends will be experienced into the future. The payment systems would continue to change today and also more expectations are there in the future especially in the presence of the digital data including the use of the electronic healthcare records. In addition, the high deductible health plans re becoming a norm in the healthcare system and patients finds it challenging to face the increasing responsibility for out-of pocket costs (Howard, 2016). The healthcare providers and the physicians need to adopt the best methods of payment that would be friendly to the patients. There is the need to expand the payment options. The medical practices should consider employing a consumer-driven and transparent collective system. The payment systems needed should be familiar with the patients. The online/digital payment system is one of the technological system that is adapted in the healthcare sector (Howard, 2016). The online system makes collection of revenue efficient for the providers and also more convenient for the patients.

Impacts of Online Payment to Patients and Healthcare Stakeholders

Increase in Collections

The adoption of the online payment system would lead to the reduction of errors that are likely to occur in the common traditional manual processing system. The administrative costs are also reduced because there is the possibility that the staff needed to conduct the manual processing is not needed. The reduction of the labor costs transfer to an increase to the collections. The physicians have the possibility of receiving the payment that is paid electronically by the patients and statistics indicate that most of the clients prefer the electronic payment whenever possible. The online payment option offers a sense of flexibility to the patients that are capable of creating online options and login their relevant details that makes it possible for them to make payment wherever they are especially the home-based care (Howard, 2016). The online platforms make it possible for the patients to pay for their healthcare services faster and easily since the system remembers them whenever they check in to their accounts. The physicians on the other hand feel motivated at the point where the patients enjoy the convenience of making payment where they enjoy the consistency in payments. The electronic payment system has evolved alongside the digital medical data systems making it possible to integrate them where the patients are directed to electronic health records where the sing-on technology (SSO) to incorporate them with a payment portals.

Flexible and Comfortable Payment Collection

The patients are capable of making payment at any location and at any time which is an additional benefit to their access to care. There is a high customer satisfaction when the patients are capable of accessing the online billing. Patients are capable of managing their healthcare payments through an instant access to their account history and their remaining balances. The patients can also have alarms and reminders that are attached to their accounts that help them by making sure they know whenever the payment period is approaching (Howard, 2016). The healthcare funds collectors also ensure that they share more payment information and details through the online platforms to be easily understood by the patients.

Reduced Operational Costs

The adoption of the online payment platform makes the payment process easy and efficient where the operational costs are eliminated or reduced. There is no needed of printing and mailing of the payment statements that would have been costly and time-consuming (Howard, 2016). The costs of printing and mailing are eliminated by promoting online payment by making the patient payment statement available online.

Improved Patient Care

Implementing an online payment option in the healthcare sector makes it possible for the patients to manage their healthcare bills minimizing the requirements of the healthcare providers and the facility management in dealing with payment instead energy and resources directed to service delivery (Howard, 2016). Since there is limited work in the payment system since the patient is capable of managing the payments then the organization uses more of its resources and funds to attend to patients on time and consider delivering quality healthcare.

Improved Patient Engagement and Satisfaction

The patients today are more engaged in their healthcare more than ever before and this is contributed by the convenient and digital way of viewing the medical data. There is a limited possibility that the patients would forget to pay for the healthcare services since they can do it in any location. The patient is likely to receive a seamless experience through the time of payment and interact in a good way with the healthcare facility management by developing the best patient portals (Morgan, 2020). An overall satisfaction is achieved the moment the patients are capable of paying for their care in any location.

More Reliable Patient Payments

Today and in the future, the online payment systems would have a bigger role to play in making sure that the physicians are paid on time and given a top priority. Offering other options to a patient makes it possible and easier for the healthcare facility or the providers to get payment for the services delivered on the required time. According of the recent MasterCard survey that was conducted indicated that 46% of the consumers have successfully switched to a contactless and digital payment and this started since the emergence of the Covid-19 pandemic. 74% of the population has been continuing using the new methods of payment even after the pandemic is over (Morgan, 2020).

The Covid-19 pandemic has made it possible for people to choose the contactless payment options in order to minimize the spread of the pandemic and this scenario has promoted the adoption of the online transactions that are likely to continue even after the pandemic (Howard, 2016). The online transactions is more advantageous for the patients to pay for their fiends in any location especially when they are being attended in a home-based care and cannot access any cash or follow the payment protocol in the healthcare organization (Cañezal, 2021). All clinics and hospitals should consider responding to the technological change in payment options and enjoy the increase in the patient payments and also lower the uncollected amounts. The failure to consider adopting the technological change would make the healthcare system lagging in terms of technology and the patients would seek for better healthcare services elsewhere.

Future Payment Systems and Impacts to the Patients and Healthcare Stakeholders

There is a trend that has been growing for years especially in the healthcare payments annual report and this has captured the growing role of the patients in the healthcare systems. In the coming future, more advancement in the payment technology would demonstrate more about offering the consumers and specifically the patients more power and role in making payments. The trends of changes in the healthcare technology and the payment systems has a huge impact to the payers (insurance firms) and the providers (hospital) where they need to immediately adjust and adopt the changes and the failure to do so would result to stagnation (Feldhaus & Mathauer, 2018). There is the need to put in place the most up-to-date healthcare payment solutions in the healthcare industry to allow it moving forward with the other technologies.

Most clients and customers are today looking for good and seamless healthcare operations to receive a quality services without much straining and this forces to providers to comply with the changes because failure to adhere to them would contribute to competition losing their potential clients. There is much transformation and improvement in the payment system in the healthcare sector that includes the transition from the fee-for-service to the value-based payment systems (Cañezal, 2021). There is much change that is expected in the coming future and this include the customization of the health payment system that makes it easier for the patient and the provider is paying and receiving services without much transactions. There is also the customization of a successful transition from fee-for-service to a value-based payment to allow more navigation and a good service delivery. Many healthcare institutions would be striving for better payment systems in future that offer extensive experiences including the one that accommodates multiple provider organizations including those for the specialty practices. The OSP is known to help much in the process of solving the specialty billing processes to ensure that payment charges is done based on the type of service offered.

References

CapMinds. (2020). 5 Effective Benefits Of Value Based Healthcare | CapMinds Blog. Capminds.com. Retrieved 24 June 2021, from https://www.capminds.com/blog/5-effective-benefits-of-value-based-healthcare/.

Cañezal, J. (2021). 5 Advantages Online Payments Bring to Your Practice. Blogs.meditab.com. Retrieved 24 June 2021, from https://blogs.meditab.com/advantages-of-online-payments.

Fattore, A. (2019). An Overview of The Economic Trends of The Healthcare Payment System in 2019 | My Billing Tree. Mybillingtree.com. Retrieved 24 June 2021, from https://mybillingtree.com/an-overview-economic-trends-healthcare-payment-system-2019/.

Feldhaus, I., & Mathauer, I. (2018). Effects of mixed provider payment systems and aligned cost sharing practices on expenditure growth management, efficiency, and equity: a structured review of the literature. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3779-1

Howard, A. (2016). The Advantages of Online Payment Collection. Insights.healthipass.com. Retrieved 24 June 2021, from http://insights.healthipass.com/blog/the-advantages-of-online-payment-collection.

Morgan, J. (2020). Ten years of trends in healthcare payments: What every CEO should know | Health Evolution. Health Evolution. Retrieved 24 June 2021, from https://www.healthevolution.com/insider/sponsored-ten-years-of-trends-in-health-care-payments/.