Value based care
Transforming Health | 05.17.13
Dr. Paul Conslato, an internist and medical director at Lancaster General Health Physicians, says that many health care providers are now placing more emphasis on patient outcomes, rather than the number of patients they treat and the cost of their visit.
“I think we’re re-looking at what we reward and incentivize and reimburse, and I think we as a nation and as a community are looking at that more than just the value of a very high-priced imaging study that might not add value to a patient’s health or other services that don’t have value,” Dr. Conslato explains.
The goals? Better clinical outcome, better experience for the patient, and at better cost.
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There are certain criteria health care providers must meet, especially if they treat Medicare patients, and there are penalties for not meeting them.
“The penalties in place for the hospital right now center around readmissions where hospitals are being penalized from Medicare for excessive readmission rates, in addition to performance around core measures, clinical areas, as well as patient satisfaction scores. That’s affecting hospital reimbursement today. There are incentives as well as penalties. In the outpatient world, your physician office, there are minimal penalties right now. There are more incentives in place, although we’re seeing these penalties start to creep into the physician practices.”
Team-based care improves care.
In a few years, the Affordable Care Act will implement more severe reimbursement penalties for health care providers that don’t adhere to certain outcome-based standards.
“2015 is a game changer, where we’ll see this value-based payment modifier in place for almost all physicians, inpatient and out-, and that’s where the environment clearly changes that reimbursement. We’ll see for the first time, for all physicians, really moving at least the next big step from static reimbursement to performance-based reimbursement.”
Conslato says there are certain ways to help make sure patients are getting the best care possible.
“A significant component and a very positive component is this team-based care. It’s not just all about the physician delivering care to a patient. It’s about this health care team where the physician is the leader of this team,” he says.
“Now nurses, medical assistants, pharmacists, social workers, care managers…roles are being redefined to deliver care to redefine our delivery model to deliver more comprehensive care as opposed to hoping that your physician had a good day in the office, and knowing that everything rested on one person’s abilities.”
Conslato says technology, such as electronic health records, is also helping improve care.
Electronic health records are helping to improve care.
“A patient won’t have a paper chart at five different practices. They’ll have one chart that’s theirs, and it’s not the physician’s medical record, it’s the patient’s. And that’s the power of the EHR that we all contributed to in developing one unified plan of care.”
Conslato says this changing system will only succeed if patients are connected to their physicians.
“It sounds corny, but it’s a powerful tool I think will make or break a lot of redesign efforts that are happening right now. If we’re not very conscious and engaged with our patients with all of our transformation, if we don’t understand they should be in the center of all our decisions, we’ll likely falter. But I’m confident that most physicians and health care teams are putting the patient in the middle and understanding what our patients think about all this transformative activity and making sure they understand their role, and their role is critical.”
He says, “It gets to a healthier society. It gets to a healthier population which in and of itself starts to lower health care cost and lowers disease burden, and then we get more health, and less health care.”