Virtually everyone in the healthcare industry agrees that something needs to be done about healthcare payment solutions. Did you know that the number one financial obstacle faced by doctors’ offices is that patients often do not ever pay for the services rendered? This can result in a wide range of problems for a practice, including lost clients and more.
The Role of Payment Systems
Fee-for-service payment systems are commonly used today; however, and they are failing for a number of reasons. The primary reason is that they give healthcare providers strong incentives to deliver more services to more people, while penalizing them financially for offering better services and improve health. This is why alternate healthcare payment solutions are currently being discussed. Two of the major ones are episode and comprehensive care payment plans.
Episode Payment
This means that customers would pay a single price for all of the necessary healthcare services needed by a particular patient for an entire episode of care. A great example is paying for all of the inpatient and outpatient care needed for a heart attack. The strength of this plan lies within reducing costs within episodes. However, this payment does not do anything to discourage unnecessarily large numbers of episodes of care among patients that have particular conditions.
Comprehensive Care Payment
Also called condition-adjusted capitation, this refers to paying a single price for all services needed by a particular group of people for a certain amount of time. For example, this would cover all the care needed over the course of a year by a group of employees. This payment method also encourages lower intra-episode costs, but really focuses on reducing the number of unnecessary episodes for care within a certain condition or group of people. It makes sense to use this option when there is concern regarding overuse of procedures or preventable hospitalizations.
Using Both Payments
Many people actually think that the best solution is to use both types of payment, discerning what is best for each patient’s situation. This is similar to how other industries use contracting and subcontracting for work. For example, primary care practices can use comprehensive care for individuals with heart disease and episode payments if one of those individuals needs to be hospitalized.