Timeline for shifting Medicare reimbursements from volume to value

Timeline for shifting Medicare reimbursements from volume to value

Health and Human Services Secretary Sylvia M. Burwell announced measurable goals and a timeline to move the Medicare program towards paring providers based on the quality of care they give patients, instead of the quantity of patients they see.

The goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018 has been set by HHS. HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs.

According to Secretary Burwell "it is in our common interest to build a health care system that delivers better care, spends health care dollars more wisely and results in healthier people. Today's announcement is about improving the quality of care we receive when we are sick, while at the same time spending our health care dollars more wisely."

According to the announcement provided by HHS, the Affordable Care Act created a number of new payment models that move the needle even further toward rewarding quality. Many health care providers today receive a payment for each individual service, such as a physician visit, surgery, or blood test, and it does not matter whether these services help or harm the patient. In other words, providers are paid based on the volume of care, rather than the value of care provided to patients.

How will this shift to quality rather than quantity impact health care? Time will tell. Regardless how we view quality vs. quantity, we have an aging baby boomer generation that may require Medicare services. The question is will there be enough quality appointments to go around?

If you have any questions about this announcement, or if you have any other questions, please feel free to comment below or send us an email at [email protected] or reach us by phone toll-free at 855-427-0427.