The United States of America lags behind Germany and Hungary in successful implementation of value-based payment models. Here are some of the challenges related to the adoption of value-based reimbursement:

Industry Facts :

According to a report by Kaufman Hall, value-based reimbursement accounts for less than 10% of the total revenue at three-quarters of US hospitals in 2014
As per a report by Boston Consulting Group, the United States (with the highest per-capita costs) ranks third in the use of value-based care
Value-based reimbursement model will take over fee-for-service payments by 2020

Challenges Related to the Adoption of Value-based Payment

Physician buy-in, technology system integration and patient engagement are some of the biggest obstacles in successful implementation of this payment model. Even learning to measure value will be posing challenges in the transition.

Hospitals will be losing revenue for a short term while experimenting with the new payment models. If they wish to delay the transition, they will be losing the opportunity to practice new skills and processes required for enhanced revenue in future.

As per a study by Availity, data accuracy issues, difficulty in making staff accept the new model and co-ordination of care will also be the top challenges for effective use of value-based payment models. Not many doctors are convinced that the new payment model will bring good rewards for their practice.

The key support required for value-based care such as IT infrastructure, common national standards, policymaker engagement, costs, and the ability to link health outcomes is not satisfactory in the US. According to the Boston Consulting Group report, the US also lags behind other countries in terms of data provision to doctors. Providers need data for managing population health and tracking outcomes.

Providers are also facing challenges related to shared savings model which is frequently used in value-based care. This compels them to operate in fee-for-service arena while tracking annual value-based bonuses. Providers will also need high level of IT capabilities to measure performance at every level.

How can Physicians Sail through these Challenges?

In order to ensure a smooth transition from fee-for-service to value-based reimbursement, practices will have to engage patients. They will have to establish communication with their staff as well as patients regarding their changing roles as healthcare consumers. Focus will be required on effective usage of IT for making information easily available to clinicians. This will help them make improved treatment decisions. Data availability will also help managers in evaluation and re-designing of operations.

How can Outsourcing Help?

Shift from volume to value-based payment will be daunting for physicians; however, it also has potential for higher reimbursements if providers spend sufficient time on patients and other clinical tasks. To make this happen, outsourcing billing needs to a billing partner like can put an end to the worries of physicians. MBC has a team of trained and certified coders and billers who have been helping physicians across the US migrate from volume to value-based payment model.

Published By - Medical Billers and Coders
Published Date - Oct-09-2014 Back

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