Shifting from Volume to Value

The transition from volume- to value-based care seems like common sense: incentivize practitioners to improve the quality of care delivery in order to deter them from the traditional fee-for-service (FFS) model. Many payers, hospitals, and physicians are considering the bundled and capitated models as alternatives to the FFS model, as well as a way to change outdated healthcare practices. Yet, there are conflicting opinions regarding what this transition could mean for emergency care, and what measures will truly change practitioner behavior.

New findings suggest, for instance, that the lump sum per patient payment under these models might threaten safety net hospitals that lose money when patients’ care exceeds the sum. Researchers say the number of patients who visited the emergency department (ED) but were not admitted to the hospital climbed 33.5% in 2010 from 2006, costing $82 billion. The number of patients admitted to the hospital after an ED visit increased 17.3%, costing $202.2 billion.

“We can’t reduce these costs with a blunt instrument,” said study author Dr Jesse Pines of George Washington University. “It has to be done in a way that is evidence-based and carefully monitored.”

These costs are also not a result of increased patient visits to the ED. ED visits only grew 7.6%, while the number of hospitalized ED patients increased 6.5% between 2006 and 2010.

Dr Pines and the other study authors suggest the development of a hybrid payment model. Tying ED quality and resource-use measures to bonus incentives in addition to the existing volume-based payments would reduce unnecessary testing and treatments. Changing physician behavior would likely come through “cost-consciousness,” and through data analysis comparisons of how their use of ED services compared with that of other hospitals.

For a value-based system to work, provider awareness also goes beyond the ED department.

“The common thread is that these are physician organizations that are driving the change,” said Mark Wagar, president of Heritage Medical Systems, a physician-led healthcare solutions organization. “You won’t get the combination of quality and cost change that is sustainable unless they are in a position to drive it.”

Around the Web

Abandoning Fee-For-Service Would Affect ER Care, Docs Say [Modern Healthcare]

Doctors Wary of Value-Based Models [Healthcare Finance News]