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US Health Care: Proposed Outcome-based Payments

Health Professional and Patient
US Health Care: Proposed Outcome-based Payments
on September, 25 2013

The experts in the US health care industry are proposing that a shift from the traditional fee-for-service method when receiving health care to outcome-based payment method should be in place immediately. The shift is said to save about $1 trillion in the cost of health care and provide patients with higher quality of service.

Outcome-based Payments

As a backgrounder, the fee-for-service method of paying for healthcare services is still enforced. It rewards healthcare providers for the complexity of services they provide and the volume of service. However, this did not necessarily result in higher quality of care. Early in the year 2000 there were deficiencies in the quality of healthcare provided in the US that were deemed serious. From the studies conducted, it emerged that pay-for-performance would be the best alternative for the healthcare recipients to focus on the quality of service that will also reduce costs. This will cut off the unnecessary medical procedures and add-ons that are normally getting tacked on to the medical bill.

On the other hand, if the healthcare providers transition to the outcome-based payment method, the focus will shift into the performance and quality of healthcare and its benefits to the patient.

Quality healthcare versus bottom line

There are many things involved in considering this method. One school of thought believes that it will have greater positive impact on medical facilities where the CEOs are also medical practitioners and not business people. In this scenario, they are already doing this type of service as they are more centered on making the patients well, avoiding remissions and readmissions. This is the opposite of other medical facilities that are more concerned with the bottom line.

With a move towards outcome-based performance as the basis for payment for medical service, informatics, new tools and productivity methods, hospital workflow and other services that will make the patient better will be sought out. This could even include the use of translators to fully communicate with patients who are not speakers of the English language.

Issues to be considered

So now the issues will be, to illustrate, how to prevent patients from acquiring additional conditions during their hospital stay, such as urinary tract infections from catheters, and pressure sores; whether the patient has been advised to quit smoking rather than take aspirin to prevent heart attacks or counseling diabetic patients to monitor their blood sugar and follow guidelines such as watching their diets and doing exercise to successfully manage their disease. This will also include patient experience during their stay, such as their satisfaction with the care given, the quality of care they received, the quality of communication with medical staff and even the state of their hospital rooms.

All this boils down to cutting costs healthcare imposes on employers, state governments, health insurers, the federal government, taxpayers and the patients, and putting in place the best practices, which is estimated to yield about $1 trillion in savings for the next decade.

Bernadine Racoma

Bernadine is a writer, researcher, professional and multi-awarded blogger and new media consultant. She brings with her a rich set of experience in the corporate world, as well as in the field of research and writing. Having taken early retirement after working as an international civil servant and traveling the world for 22 years, she has aggressively pursued her main interest in writing and research. You can also find Bernadine Racoma at .

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