The New England Journal of Medicine’s perspective on payment reform:
Care management, with its cost-reducing potential, will not spread widely in the health care system without substantial changes in payment policy. If hospitals profit from unnecessary readmissions, they are unlikely to adopt effective hospital-to-home care-management programs. If primary care practices are not reimbursed for the work of a registered-nurse care manager, they will not hire one unless they share in the savings generated by reducing hospital admissions and emergency department visits. Other obstacles include nursing shortages and the paucity of training programs for nurses to become effective care managers.
Current financial incentives sometimes create less revenue for better care. In a fee-for-service (FFS) system, rework (i.e. unnecessary readmissions) can be profitable because providers are paid per visit, not a cumulative clinical episode.
The first line of the article cites a stat noted often that deserves reiteration:
In the United States today, 10% of patients account for 70% of total health care expenditures. Many patients who require high-cost care are people with multiple chronic conditions, many medications, frequent hospitalizations, and limitations on their ability to perform basic daily functions due to physical, mental, or psychosocial challenges.
Chronic disease, such as congestive heart failure, diabetes, and coronary artery disease commonly occur in the elderly (though in the case of diabetes that is quickly changing). This sector of the population is also growing faster than any other.
Cost reform must be strategic and piece by piece unravel the complex knot that now represents the US health care system.
Related posts:
- When Health Care Data Takes Effect
- On the Health Insurance Industry’s Exemption from Anti-trust Regulations
- Making Online Medical Records Functional
- Link Stream – Oct 23rd, ‘09