Based on the past and the current state of healthcare in the United States, healthcare reimbursement is expected to change dramatically in the future. With the ever-rising medical costs and the call to reduce such costs, I think the reimbursement based on the fee-for-service will gradually disappear and replaced with models that focus on equality and cost-effectiveness. The United States of America is the leading country globally in terms of medical costs, yet its healthcare system is not ranked the best in the world. This shows that close to 50% of the health care spending in the US is wasted or is harmful to the economy ( Raghupathi & Raghupathi, 2016 ). In 2016, the health care costs were 18% of the GDP and are set to double if measures are not taken to eliminate the wastes. This trend risks the economic growth for the future as the health care sector leaves little money for other sectors such as education and infrastructure.
As a result of the rising costs of health care, there has been growing pressure for the reduction of the reimbursement. The emerging merger of the key insurance companies has provided the resulting giants with more leverage to negotiate for the lower reimbursement rates against the providers. The increased call by the policymakers to cut the costs has also exerted pressure to have the reimbursement rates reduced. This trend put the future of reimbursement at an uncertainty with more expectation for the rates to reduce and be based on the quality rather than just a fee-for-service payment ( Henkel & Maryland, 2015 ). As a result, the Medicare has continued to look at the new methods to reimburse the care providers and suppliers with the key focus on the reduction of the expenditures while at the same time rewarding those who can turn around the health care cost curve downwards. Medicare has also been drawn by the need to assess and refer patients or treat them at home rather than moving them to the health centers.
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The recent recommendation to reduce the healthcare expenditures over both the long and short run is through the restriction of the reimbursements based on the quality of the services as well as the patients’ outcome. The reimbursement rates will focus on the ability for the care providers to provide the quality services for the patients and reduce readmission rates. The health care system is currently shifting from the quantity of care to quality by rewarding the providers with high quality and best patients’ outcome ( Henkel & Maryland, 2015 ). Based on this model, the reimbursement costs are expected to reduce in the future in a move that will see the overall healthcare costs decrease.
The CMS has also introduced the Hospital Consumer Assessment of Healthcare Providers and Systems. This system is aimed at providing a standardized survey asking the patients about their feeling towards the care. These involve the effectiveness of the care as well as the proficiency of the caregiver. Such results are captured in a database and used to decide whether to increase or decrease the reimbursement rates. Currently, the CMS is focusing on the ways to reduce the reimbursement rates by shifting from a poor quality fee-for-service system to a high quality and efficiency model ( Edlin et al., 2014 ). Therefore, the healthcare sector should prepare for such changes in the reimbursement because it is what the future holds if the wastes within the healthcare sector are to be reduced. The changing focus on the quality and effectiveness of the service is playing a key role in influencing the future of the reimbursement. I, therefore, suggest that in the future, the reimbursement rates are expected to change and will depend on the quality and effectiveness of the care rather than the fee-for-service model.
References
Raghupathi, W., & Raghupathi, V. (2016). Big data analytics in healthcare: promise and potential. Health information science and systems , 2 (1), 3.
Henkel, R. J., & Maryland, P. A. (2015). The risks and rewards of value-based reimbursement. Frontiers of health services management , 32 (2), 3-16.
Edlin, R., Hall, P., Wallner, K., & McCabe, C. (2014). Sharing risk between payer and provider by leasing health technologies: an affordable and effective reimbursement strategy for innovative technologies?. Value in Health , 17 (4), 438-444.
