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What is meant by payment reform?

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HITECH: Wedding IT to care delivery and payment reform

WASHINGTON – Experts say the federal HITECH Act should be "wedded to a strong commitment to provider payment reform" to push transformation in the nation's healthcare system.

What precisely, is meant by payment reform? Does it mean an end to double billing, where both private insurer and medicare are billed 100% for a procedure (common practice)? And end of doctors giving two different names to the same procedure and billing twice (again, a common practice)? Or something else?

None of the reforms that are being offered seem to involve giving care to those who presently do without?

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Submitted by lambert on

From the same source:

Peter Basch, medical director of ambulatory clinical systems at MedStar Health, a non-profit, community-based health system serving the Baltimore/Washington region, said there are clear benefits of having an electronic health record, but just having one won't bring about quality improvements. In order to generate value, he said, EHRs must provide preventive care measures, chronic disease management, care coordination, non-visit-based care (or "e-care") and knowledge-based medication management.

But before there can be widespread adoption of these EHR models, Basch points out that the payment system has to change to one that recognizes the quality of healthcare outcomes.

The current payment system "hinders innovations and leads to mediocre performance of existing healthcare IT systems," he said.

If you think you've got a hard time appealing with insurance companies, just wait 'til you have to appeal to an algorithm.

This whole thing should be giving everyone the creeps, and that it's the only thing Obama's excited about does not bode well.

Submitted by jawbone on

so the providers don't have to worry about going after the patients who end up not being able to afford the high deductibles, etc. The credit card company goes after them instead. The cards can be used only for health related expenses.

I read about it when I was in WI, but didn't pull up anything in my admittednly quick search.

But it is a new payment plan....

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Submitted by Kick Baucus to ... on

that partners with Jonathan Bush (yes, that Bush) Jr. in athenahealth? The two met at Booz Allen Hamilton and later founded athenahealth to replace, I repeat fully REPLACE, billing in the US by using electronic medical records to outsource billing to India. Oh yeah, that'll save money.

(I don't know if they're going to get the business they hoped for since Gold Sacks just downgraded their earnings outlook. Maybe Todd is having to lie low, but he previously bragged about his plans to outsource all front, back office medical billing in an interview.)

The other part of this fabulous innovation is to put medical decisions more firmly into the hands of the insurance companies, and everybody LOVES the way insurance companies practice medicine. They will also centralize research, which will maximize profits if not research.

The only good thing about any of this healthcare reform fraud is watching the Democrats play dumb. They're really good at it.

Submitted by hipparchia on

seems to be code for 'pay for performance' [it goes by other names such as 'incentivizing quality' or 'pay for outcomes' in which the doctor/hospital is paid 1% or 2% more if certain quality measures are followed or certain measures of patient improvement are met] and also for getting further away from the fee for service model.

france, canada, germany, japan, all use fee for service. canada adopted some of our bundling method of payment, and france tried it for a while [iirc, they gave it up, or at least cut back]. none of these countries uses any kind of p4p that i'm aware of.

funny thing, all these other countries still spend less on healthcare than we do. how do they do that? /snark

one thing to note about france's health care system:

Doctors only agreed to participate in compulsory health insurance if the law protected a patient's choice of practitioner and guaranteed physicians' control over medical decision-making. Given their current frustrations, America's doctors might finally be convinced to throw their support behind universal health insurance if it protected their professional judgment and created a sane system of billing and reimbursement.