Healthcare Policy
Reimbursement Reform: Creating Payment Systems to Accelerate Value-Driven Health Care
A growing number of healthcare professionals around the country are increasingly frustrated by healthcare payment systems. Why? Healthcare systems are not providing the highest quality care possible for the money currently being spent.
Current healthcare payment systems provide significant financial penalties and disincentives to providers (hospitals, physicians, and others) who provide quality, efficient care (e.g., lower-cost services, higher-quality care, cognitive services, preventive care, etc.). In fact, there are significant incentives for providing expensive, inefficient care (e.g., invasive treatment, use of technology, etc.)—irrespective of its outcome.
The same or higher quality health care could be provided for less money than is being spent today. Appropriate changes to the structure of payment systems have the potential to increase the quality and/or reduce (or at least control the growth in) the costs of health care.
There have been a number of efforts in recent years to create "pay for performance" systems that add new rewards or incentives to existing healthcare payment systems in order to encourage lower-cost, higher-quality health care.
But that's not enough. There is a growing consensus that in order to achieve the most efficient, effective, and sustainable improvements in quality and reductions (or slowing the growth) in costs, the penalties and disincentives in the underlying healthcare payment system must also be eliminated or modified.