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Health Care Providers Slow to Implement Risk-Based Reimbursement Models

With significant changes in the medical field due to the passage of the Affordable Care Act, the current fee-for-service health care model is likely on its way out. However, though it may be inevitable, many health care providers are slow to implement value-based models. This is so in part due to the fact that the new model does not offer the same financial incentives to health care providers as traditional fee-for-service practices.

A value-based or risk-based model emphasizes improved patient care in a preventative fashion that would be delivered at a lower cost. This is a significant shift away from the fee-for-service model where reimbursements were tied directly to each service a patient received.

Doctors are reluctant to embrace these new reimbursement models. The fee-for-service model offers many physicians higher financial incentives even if they are not necessarily serving the best needs of their patients in every situation. The new risk-based model promotes a healthier population, which would likely cut into a doctor’s bottom line. Due to this, many advocates of this model suggest that doctors should be compensated for providing quality measures under the newer model.

Some of the practices that would be promoted and offered under the newer model include procedures such as colon cancer screenings and other preventative practices that are meant to prevent serious diseases and other health problems. If doctors and insurers can communicate and partner, they should be able to implement these practices in a way that makes both business sense for their companies as well as practical sense for their patients. This would be a shift in the way that health care providers practice, but holds the promise of promoting a healthier population.

If you have questions about the legal considerations associated with implementing new business policies within your health care practice, speak with a knowledgeable New York, New Jersey, and Pennsylvania health law attorney at Buttaci Leardi & Werner, LLC.

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  • Posted on: Feb 23 2015