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What is Fair Payment for Outpatient Care?

Rene Letourneau, for HealthLeaders Media, March 25, 2013

As he sees it, this swift evolution of healthcare technology is great for patients who can receive more—and often better—care without having to be hospitalized, but it has the potential to result in providers being underpaid for the services they are giving on an outpatient basis.

Becoming part of the panel, Zimmer says, is a chance to have a positive impact on provider rates. "The outpatient panel is in an opportune position to help minimize the friction between a rapidly changing environment and the largest payer in the country, which is CMS, who does phenomenal work, but needs to be very driven by facts and data in their historic database," he explained.

"There is a natural conflict that exists between the forward-looking technology companies and process innovators and the retroactive-looking team at CMS."

The panel can help in bringing the two sides together, Zimmer says, noting that one of his personal goals as part of the panel is to "help translate and understand that friction."

Despite the steep time requirement, Zimmer and the leadership team at SSM believe there is significant value in his participation on the panel. "We decided it was a role that would be meaningful and worthwhile as an expenditure of time, which is the most valuable resource for all of us, so I don't take the commitment lightly. … There will be dramatic evolution of care delivery in our country over the next four years, and it is exciting to be at the forefront of that."

Zimmer attended his first panel meeting in mid-March, which was held via teleconference, although panel members typically meet in person.

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1 comments on "What is Fair Payment for Outpatient Care?"


Daniel Ross (3/25/2013 at 1:58 PM)
The outpatient hospital, CMS negotiations result additionally impacts the fees being paid by commercial health plan sponsors. Typically, the dollars not paid by the public plans were cost-shifted on to the commercial payors. One wonders how this committee can impact the Medicare cuts imposed by PPACA?