As Insurers Balk on Risk Sharing, Providers Take Charge
And guess who's at the end of that chain of responsibility? Health systems, as they seek to obtain the patient's portion of the responsibility for the bill, which seemingly grows each year with higher copays, deductibles and "coinsurance." That strategy, if you can call it that, has a limited shelf-life.
One CFO told me that high deductible health plans are generating not only declining volumes for a variety of inpatient and outpatient services, but also "a level of hate" from patients toward the hospital or health system, which is left to collect the patient's share of the bill.
Indeed, hospitals, physicians, and outpatient facilities are often obligated through their commercial contracts to attempt to collect that portion.
Not that hospitals and health systems are particularly enthused about moving from fee-for-service reimbursement to sharing risk on quality, utilization and outcomes, among other metrics, but in many geographical areas, they seem to be getting little cooperation from payers in testing risk-based payment strategies.
Why? According to hospital and health system CFOs, payers say they aren't ready.
The lack of progress isn't attributable to the hospitals and health systems themselves. Indeed, many aren't waiting for insurers to implement risk sharing into their contracts, and instead, they're experimenting on their own—especially those that already own health plans.
- FDA hopes hospitals will switch to newly regulated pharmacies
- CMS Sets 2014 Pay Rates for Hospital Outpatient and Physician Services
- New G-Codes to Pay Doctors for Broad Array of Non-Face-to-Face Care
- States Rejecting Medicaid Expansion Forgo Billions in Federal Funds
- Why You Should Involve Patients in Nursing Handoffs
- Not-for-Profit Hospitals Find Opportunity Amid Uncertainty
- Substance Abuse Resurfaces Among Anesthesiologists in Training
- Douglas Hawthorne—A Chance to Do Something Big
- Safety Net Executives Renew Call to Preserve DSH Payments
- The Most Polarizing Topics in Healthcare IT