There’s a new player in town. In case you haven’t heard, his name is VBR – value-based reimbursement. He’s smart. He’s tough. He’s out to break you down and build you up. And if you’re a healthcare provider, there is nowhere to hide.
For several years now I’ve been writing about the “coming” revolution in healthcare reimbursement as the system moves from a fee-for-service approach (ie, the more you do, the more you earn) to one based on cost and outcomes, aka, value. Well, the revolution has begun. Just consider:
➢ On April 1, nearly 70 hospital systems will switch from billing separately for each component of a knee or hip replacement to receiving a bundled payment for all care provided from the time the patient enters the hospital until 90 days after discharge. Just consider the possibilities!
➢ Two weeks ago, the Centers for Medicare & Medicaid Services (CMS), which is driving the value-based revolution, announced a proposal to change the way physicians are paid for drugs administered in their offices (mainly oncology medications).
Today, doctors get the average sales price of the drug plus a 6% administration fee. It doesn’t take a lot of math to figure out that the higher the cost of the drug, the higher the administration fee. This provides a perverse incentive to use higher-cost drugs when lower-cost, equally effective options are available. CMS hopes to annihilate that incentive with it’s new plan, part of which involves paying a flat fee for administering certain drugs.
➢ The agency is also taking applications for a 5-year pilot of the Oncology Care Model, in which Medicare will pay practices an additional monthly fee for each cancer patient in exchange for promises to better coordinate care and provide the kind of round-the-clock outpatient services designed to keep patients out of the emergency room and hospital.
These are just the tip of the value-based iceberg.
Want to know more? Then register for my free (yes, I said free) webinar on March 30 at 1 pm eastern. If you do anything in the healthcare field and you didn’t know about the three initiatives I listed above (and the 10 or more I didn’t) then you need to attend.
Can’t be there in person? No worries. It will also be available on demand.