The Changing Landscape of Reimbursement for Healthcare Services The Necessity for Changes in Reimbursement Models Politicians and economists agree that our healthcare system is going broke and can no longer sustain itself financially. Much of the focus has been on Medicare, but all aspects of healthcare are being affected. This poster will present the evidence identified to increase costs of health care, proposed reimbursement models under discussion, and anticipated impact on therapy and diagnostic services. The ultimate goal is to control and reduce the cost of health care while increasing quality. The Medicare Payment Advisory Commission, the Institute of Medicine, and the Centers for Medicare and Medicaid Services agree that the current reimbursement system encourages excessive services and excessive reimbursement Evidence cont’d Proposed Reimbursement Models Value based purchasing Aligns payment to delivery of services and quality of care (read: outcomes) Episodic / periodic payments Single payment for date of service or several dates of service Bundled payments Single payment for combined services and supplies, or Grouping several procedures into one new procedure code Medical home model PCP becomes coordinator and health care manager for patient PCP paid to review Incorporate functional scale for accountability and measure of intervention effectiveness (e.g., International Classification of Function) Impact on Graduate Student Training Distinguish between “graduate school protocol” and customized protocol based on clinical question / issue Greater emphasis on clinical judgment in diagnostics and therapy Focus on patient-centered care and incorporate patient / family goals Measure outcomes for activities of life (not ADLs, but activities of life) Focus on quality of life in addition to resolving a particular health or functional problem Incorporate best practices into training regimen (Evidence-based versus consensus-based health care) Robert C. Fifer, Ph.D. University of Miami Mailman Center for Child Development Value of Health Care Research and Education Support Impact on Health Care Services Eliminate incentive to “do more to be paid more” Require knowledge of cost of service delivery Justify each procedure diagnostically or therapeutically Therapy: Abolish tradition 2-3 therapy sessions per week Therapy: Maintain quality with fewer services Therapy: What additional resources can be had without increasing overhead Do what is needed, then stop Develop alternative delivery systems (e.g., telehealth services) Evidence Motivating Changes in Healthcare Reimbursement Health Care Costs for American Families Source: Milliman Medical Index CountryHealth Care Rank Per capita spending rank France14 Italy211 Spain724 Austria96 Japan1013 Norway1116 United Kingdom 1826 Switzerland202 Germany253 Canada3010 United States371 Additional Factors Affecting Costs 1.Fee for Service model 2.Race and ethnicity 3.Socioeconomic status 4.Uninsured (51 mil.) and under-insured (60 mil.) => ER as primary care service 5.Pharmaceuticals 6.Language disparities between patient and provider 7.Hospital readmissions for same diagnosis 8.Malpractice suits causing defensive medicine 9.End of life care (15% Medicare budget devoted to last 2 months of life) “We practice according to how we are paid.” Peter Hollmann, MD, Chair, AMA CPT Editorial Panel Per Capita Health Care Spending Among OECD Nations Out of Pocket Expenses for Family of Four WHO World Health Rankings vs. Spending Value will be patient-centered, focused on three main factors, and divided by cost of service. All services will be evaluated for retention or elimination.