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post1.docxWith the recent adoption of value-based healthcare, health care administrators will face a tremendous amount of pressure to modify their facilities in a way to accommodate to the changes while maintaining financial stability. There are multiple infrastructure changes that will have to be made within healthcare that will particularly affect the how services are provided in hospitals. Prior to the healthcare reform, there was a disturbed continuity between outpatient care by primary care providers and hospital care (Doohan & DeVoe, 2017).
In 2015, President Obama enacted the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA), which majorly affected the way healthcare was conducted (Markovitzfa, et.al.,2018). This enactment was an attempt to change healthcare from a financial system of physician payment to a more value-based care system (Markovitzfa, et.al., 2018). One of the major reasons for the transition into the value-based care model was to provide lifelong care with an aim to ultimately reduce medical costs by encouraging patients to initially seek primary care to avoid high cost hospital bills (Doohan & DeVoe, 2017).
There are two value-based routes a healthcare organization can take if they participate in Medicare: the Alternative Payment Model (APM) and the Merit Based Incentive Payment System (MIPS) (Doohan & DeVoe, 2017). The APM focuses on physicians who provide care by Accountable Care Associations (ACO) and other models that have two-sided risk arrangements (Doohan & DeVoe, 2017). The APM provides an absolute 5% incentive payment to participating organizations, an incentive that the other system does not provide (Doohan & DeVoe, 2017). Healthcare administrators in all facilities that accept Medicare will have to be aware of the payment changes and how to adequately adapt.
A benefit for physicians and patients within the value-based care system is the change in the transparency of shared information from physician to physician. Hospitals are an important factor in this change by updating primary care physicians of any incidents, tests and scans that occurred while in the hospital for acute care. In order for hospitals to make this transition into value-based care, the administrators within the hospital will have to enforce the use of information technology that will readily communicate with many healthcare providers (Doohan & DeVoe, 2017). With this new form of communication, the hospital physicians will be able to share the patient’s information with the patient’s primary care provider so that the post-acute care is as thorough as possible, and healthcare administrators will play a major role in assuring that the information is relayed correctly. The adoption of the new information technology will also allow for hospitals to access information about the patient before providing care that will result in a more efficient, holistic treatment.
Additionally, hospitals may find providing value-based care particularly difficult, because they will need to send many of their patients to alternative care facilities that are less expensive, which will result in a financial loss that may not be adequately compensated by the ACO bonuses (Doohan & DeVoe, 2017). Although sending patients to other facilities could negatively affect the hospital, there may be an ultimate reduction in care provided without compensation that could outweigh the loss of business (Doohan & Devoe, 2017). Provided that the new, value-based care system awards compensation for quality care provided to patients; administrators will need to focus on making changes that provide a more quality experience for the patient along with how to continually receive adequate funds for the hospital to remain providing their services optimally.
References:
Markovitzfa, A., Ramsay, P., Shortell, S., & Ryan, A. (2018). Financial Incentives and Physician Practice Participation in Medicare's Value-Based Reforms. Health Services Research, 53(4), 3052-3069.
