The regulations surrounding America's healthcare system are changing - again. Running a successful hospital in the United States requires constantly adapting to the ever-changing policies, and staying on top of everything can be a challenge. The Hire Connection, LLC aims to make things easier on our clients by providing professional medical recruiting services and valuable information about the changing medical scene. This week, we're here to examine one of the major upcoming shifts: the switch to value-based payments.
Value-Based Payments vs Fee-For-Service
Traditionally, doctors and hospitals billed their patients according to a standard fee-for-service structure. According to this method, doctors were able to charge their patients for services any rendered, such as the tests they ordered and the number of visits they had with each patient. The actual benefits each patient received were not factored into the charges for the services rendered.
Under the value-based payment structure, on the other hand, doctors are compensated based on the quality of care they actually deliver to their patients. Instead of billing for the number of visits, physicians can only bill their patients in proportion to the benefits the patients get from the care they received. (Keep in mind, of course, this is a very general summation of the process.)
What Will The Switch Mean For Your Hospital?
This is an interesting switch for the healthcare industry, because (unlike many other major shifts) hospitals are not specifically required to switch to value-based payment methods. However, more and more hospitals are making the transition, and patients (for the most part) are very enthusiastic about this new payment structure. While his patients' well-being should be every doctor's primary concern, many individuals are concerned that this is not always the case. These patients believe that since the value-based payment methods mean that doctors are only paid for the quality of care they deliver, they will be more focused on taking great care of their patients.
Because of this overwhelming patient support, many independent physicians who tried to adhere to the fee-for-service structure are losing their clientele base and being forced to instead join large hospitals and healthcare systems. Consequently, major hospitals are experiencing growing pains in addition to the general challenges associated with adjusting to a new payment structure.
THC Can Help With This Transition!
In order for your hospital to successfully survive the switch over to value-based payment methods, you will need to find and recruit top-quality physicians who will be genuinely dedicated to your patients' success. As the best medical recruiting company in the U.S., The Hire Connection has the experience you need to find these candidates! Contact us when you are ready to get started.
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Running a physician-owned practice can be a be a lucrative endeavor, but recent changes in the medical world are imposing major financial pressures for these practices. Government regulations are closing in, drastically changing the ways that physicians run their practices and demanding that new requirements be met. These new regulations and requirements are taking their toll on the profits previously enjoyed by physicians across the nation. The Hire Connection is here to provide an inside look at some of these new pressures.
Expensive Equipment
The cost of the equipment needed to run a successful practice has been steadily rising for some time, and it does not show any signs of leveling out in the near future. As if the rising costs of vaccines and general medical supplies were not enough, the impending coding regulation change to ICD-10 demands even more expensive equipment and extended training for staff to learn how to use this complex new system. According a study by the American Medical Association, preparing for ICD-10 may cost practices at least $56,000. (See our previous blog to learn more about the implications of ICD-10).
As a result of these increasing financial pressures, a 2014 survey by Medical Economics found that more than 84% of physicians claimed that their practices were doing the same or worse financially than they were a year ago. That means that less than 16% reported financial growth in the last year.
Value-Based Payments
Until recently, healthcare facilities operated on a fee-for-service basis. This allowed them to charge for individual doctor visits, the tests they ordered, and the other basic services involved in patient care. New regulations are now requiring that physicians convert to a value-based payment system, which dictates that they only be paid for the value of the care they deliver. That is, physicians are required to demonstrate improvements in their patients' conditions in order to be compensated for their efforts.
The transition to value-based payments also requires physicians to report their Physician Quality Reporting System (PQRS) data to the Centers for Medicare and Medicaid Services (CMS). Physicians who fail to properly submit these reports are seeing their reimbursements cut by 1.5% this year, and that number will rise to 2% in 2016. Even the experts are unable to predict how long it will take to fully transition to this new reporting method and payment structure, but they predict that physicians across the nation will suffer financially during this transitional period.
Reimbursements
In order for physicians to be paid, they must be reimbursed by the insurance companies covering their patients. Unfortunately, these insurance companies are increasingly denying claims, making it harder for physicians to be compensated for their efforts. Insurance companies are frequently denying claims based off of minute errors, such as the modifiers not matching the procedure codes or slight discrepancies between the way the doctor submitted the patient's name and the way the insurance company has the patient's name on record (these discrepancies can be as slight as a missing hyphen in the last name).
The increasingly uncooperative behavior of insurance companies is taking a financial toll on physicians across the country. As a result, more and more physicians are choosing to work outside the system by not accepting insurance. This allows them to treat their patients as they see fit, rather than conforming to the methods set by insurance companies, and ensure that they are paid for their services.
The Hire Connection Can Help Ease The Burden
As these financial pressures create a greater and greater strain on physician-owned practices, finding the right physicians (and the right compensation level) for these facilities becomes even more critical. In addition to helping you find the right candidate for your opportunity, our medical recruiting company can help you design a proper compensation package that will entice potential candidates without creating a greater financial strain on your practice.
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