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Enter Hybrid Reimbursement!
By Dr. David Edward Marcinko MBA CMP®
http://www.CertifiedMedicalPlanner.org
As we know – not withstanding ACOs or bundled care reimbursement models – current medical reimbursement structures involve the submission and payment of medical CPT® coded claims.
Still, some doctors feel they need to “up-code” to maximize revenue or even “down-code” for fear of having a claim denied.
The Outcome
The upshot is that contradictory business goals bastardize the system into a payer versus provider tug-of-war, with patient care as a potential bargaining chip. Instituting quality metrics should be included in this equation and, a hybrid reimbursement model may be a viable option while integrating quality care metrics and reducing costs for all stakeholders.
Enter Hybrid Reimbursement Models
This hybrid reimbursement system might use a two-payment structure.
- For the first payment, claims would be paid at hypothetical rate of 60% within one week of submission.
- The second payment, consisting of the remaining zero to 40% of some total maximum allowable fee, be paid quarterly. It would be based on scores like patient satisfaction and stewardship of healthcare resources by analyzing a statistically valid sample of patient encounters taken from the electronic health record.
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Assessment
Such a hybrid system would remove unnecessary steps, like re-submitting claims, and would lower the operational and administrative costs of claims processing. These changes would decrease operational cost and drive quality stewardship of the healthcare dollar.
Conclusion
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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
- PRACTICES: www.BusinessofMedicalPractice.com
- HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
- CLINICS: http://www.crcpress.com/product/isbn/9781439879900
- ADVISORS: www.CertifiedMedicalPlanner.org
- FINANCE: Financial Planning for Physicians and Advisors
- INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
- Dictionary of Health Economics and Finance
- Dictionary of Health Information Technology and Security
- Dictionary of Health Insurance and Managed Care
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Filed under: Health Economics, Practice Management | Tagged: David Edward Marcinko, economic hybrid medical reimbursement |
The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants 
Percentage of Physician Compensation from Sources of Payment
1. 86% Tradtional (salary or FFS)
2. 30% Value-based payment models
3. 16% Episode-based payment
4. 13% Bundled payments
5. 10% Shared-savings arrangements
6. 10% Capitation payments
7. 4% Shared-risk arrangements
Source: Deloitte University Press
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