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Value-based Payments: Is There any Value for Orthopedic Billing?


Article - Value-based Payments: Is There any Value for Orthopedic Billing?

The switch to value based reimbursement has turned the traditional approach of healthcare industry on its head, causing tremendous changes in the way providers billed for care. Instead of the number of visits and tests that are performed (fee-for-service), practitioners payments are now based on the quality and care they provide (value based care). How will these changes affect the various practitioners around the U.S., especially orthopedics? How will they be affected in the near future?

According to Lynn Scheps, Vice President, Government Affairs and Consulting Services-Montvale, "Orthopedists, and other specialists were indulged as an afterthought and many headed to meet meaningful use by claiming several exclusions". For meaningful use, clinical quality measure requires that an orthopedists report extraneous measures. They are ought to report nine quality measures, but only four or five are relevant to their specialty practice.

But now, the government is shifting its focus from' fee-for-service' to 'value based care'. This transition to value based is one of the greatest challenges for Orthopedics billing services. Having implemented this model, it is now taking a form of Accountable care organizations (ACO's), bundled payments, and vast care for joint replacement program.

Ms. Scheps says "The demanding Medicare is looking to shift the risk for cost and quality to the providers and far off from Medicare,". The Centers for Medicare & Medicaid Services (CMS) stated that its meeting its goal of 30% of 2016 payments being value based, and by 2018 this count will increase to almost 85%.

Managing the Data

Orthopedists are trying to figure out about how their patients are doing right now. The current measurement of quality only tracks the rate at which the patient's outcome surveys are completed. But, physicians are looking out for tools that analyze the actual outcome itself. By analyzing the stats, and their current performance and outcomes, the orthopedists can setup a strategy to improve outcomes and control the costs. Lester Parada, Senior Implementation Manager states, "What the practice wants to capture and examine is different than what they are currently required to apprehend and analyze."

Although orthopedic surgery was the prime focus of the value based care model, population health and total cost control also appeared as priorities. As uptake of value-based payment continues, practitioners will need to find new ways to reduce needless spending and keep orthopedic patients healthy.

The care model is designed in such a way that it improves quality, cost, and outcomes for a person's orthopedic episode of care and it financially rewards orthopedic practitioners.

For patients, this model will provide a more coordinated care experience and reduction in complication rates.

Arranging for the Problems of Value-based Reimbursement

Making the progress to a value-based reimbursement model requires:

  • Transiting from the traditional care model into a network care model, both for increased care coordination and the capability to scale effective involvement with the patient population
  • A significant increase in the need to gain, cluster, and examine data across a healthcare network
  • An coherent financial and clinical platform for a common sight of the patient across care settings and over time
  • Reshuffle institutional structure to billet value-based payments. This different structure can also help healthcare providers spot changes that could minimize operating cost and boost efficiency
  • Swelled access to care, which can lead to additional patients and less network leakage
  • Treating a higher number of chronic diseases
  • Several chronic conditions and sick patients among the aging populations.

With these investments happening now, and with a deep knowledge of Orthopedics billing guidelines, practitioners know that they can take the Orthopedics billing practice into the future without giving up on what matters to the practice, and patients.

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