PARADOX: Value Based Care

BY DR. DAVID EDWARD MARCINKO MBA MED CMP

Sponsor: http://www.CertifiedMedicalPlanner.org

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A young clinician representative advising to consider the cost versus value of medicine. Health care concept for economic cost-effectiveness analysis, driving down medical costs, improved access.

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Value Based Care Classic Definition: Value-based care is a type of payment model that pays doctors and hospitals for treating patients in the right place, at the right time and with just the right amount of care. You can look at it as a financial incentive to motivate healthcare providers to meet specific performance measures related to the quality and efficiency of the process. The same way, it penalizes weaker experiences, such as medical errors. The concept is often counter-intuitive.

CITE: https://www.r2library.com/Resource/Title/0826102549

Modern Circumstance: As healthcare costs continue to rise, value-based care has been growing in popularity compared to the traditional fee-for-service method.

Think: HMOs, PPOs, capitation payments and Medicare Advantage [Part C].

Paradox Examples:

  • Payment: A physician paid through fee-for-service compensation might like to see a packed medical office waiting room. More patients and services equate to higher pay. But, the same doctor paid through a VBC contract might wish to see an emptier waiting room as s/he will get the exact same daily pay for seeing fewer patients and working much less.
  • Prospectivity: Traditional Fee-for-Service medicine treats sick patients. VBC medicine seeks to keep patients healthy and out of the doctor’s office. 

Nursing Capitation: https://medicalexecutivepost.com/2024/07/07/on-nursing-capitation-reimbursement/

COMMENTS APPRECIATED

Thank You

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