Value-based care bases reimbursement to providers on quality rather
than quantity of care and rewards for efficiency and
effectiveness.Traditional fee-for-service reimbursement pays providers
based on what healthcare they provide to a patient, rewarding for quantity
and not quality. (LaPointe, 2022) What I see as a concern with value-
based care is the question of what defines quality when care is
provided.Should a surgeon not be reimbursed for a procedure they
performed if the patient dies under their care? Of course not.Just
because a patient dies does not mean that the work was not of quality.In
medical care, there are so many variables that impact the outcome,
regardless of the quality of care provided and the physician cannot be
penalized for the outcome not being positive.Negligence is a complete
other situation.A negligent provider is guilty of not providing quality care
because of a decision made that did not lead to the proper care. The
problem with value-based care is some situations require more time and
effort than just performing whatever the reimbursement is for.Cranking
out 20 surgeries in a day, no matter how simple, is not the best choice
because each patient is different.A “simple” procedure might not always
be simple for each patient and reimbursement should not be based on
performing more, no matter the quality.Quality always matters,
especially in healthcare.
There must be a way to meet somewhere in the middle, in my opinion,
to be effective and efficient.If value is defined as, “a fair return or
equivalent in goods, services, or money for something exchanged, and
the monetary worth of something, and the relative worth or importance”,
(Value definition,n.d.) finding a way to apply a definition to healthcare
can be used to make the system better.In business, improving quality
and reducing costs increases value- and the same definition can be
applied in healthcare.If quality goes up, which can be measured as
population health, successful procedures, cure rates, and more, then the
value of the services that the healthcare teams involved goes up.Tying a
cost to care that is defined as high quality increases the value of the
care.For example, if a doctor can guarantee a person would be cured
but the cost would be $1millioin- the person who needs to be cured would
consider the cost to be of high value and justified.
No matter how many people agree or disagree with government
intervention with cost efficiency guidelines, it will happen to some
degree.In 2020, the federal government spent $14.1 trillion on
healthcare- positioning them to have a say in healthcare.
(Historical,n.d.)That being said, I do not believe that the government
should have a central position to issue practice guidelines based on cost
efficiency alone. Despite the high dollar amount the government pays, the
government does not fund 100% of the healthcare in the country. There
are government agencies that monitor and manage quality, and I believe
that these agencies along with other groups who understand healthcare
better should collaborate to manage the quality of the system.They are
experts in healthcare and would be better equipped to take observations
and make changes as needed. An advantage of government being part of
the central position in healthcare is that if subject matter arises that might
require laws to change, it will be easier to make this happen if they are
part of the team making observations and decisions.
References
Historical. CMS. (n.d.). Retrieved May 1, 2022,
fromhttps://www.cms.gov/Research-Statistics-Data-and-Systems/St
atistics-Trends-and-Reports/NationalHealthExpendData/
NationalHealthAccountsHistorical
LaPointe, J. (2022, March 2).What is value-based care, what it means for
providers?RevCycleIntelligence. Retrieved May 5, 2022,
fromhttps://revcycleintelligence.com/features/what-is-value-based-care-
what-it-means-for-providers
Merriam-Webster. (n.d.).Value definition & meaning. Merriam-Webster.
Retrieved May 5, 2022,
fromhttps://www.merriam-webster.com/dictionary/value
