Obamacare’s New Payment Method for Quality Health Care


Obamacare’s new payment method for quality health care has drawn debates in the U.S. recently. The latest move of the government is in ensuring that healthcare is rated according to the quality of the services.

Traditionally, Medicare payments are based on “pay for service,” such as, paying physicians for CT scan, physical exam or surgery, regardless of whatever the outcome of the patient is. Last year, Medicare’s budget based on this model was $362 billion.

Lawmakers have been considering for years, that the health care system should move toward alternative payment models which are tied to quality care, pushing ways to emphasize quality care more than quantity. They further say the current model could make health providers perform services more than needed, which balloon health care costs.

Obamacare’s bold move is to implement a new payment method for quality health care, that is, to change the way the government pays Medicare doctors – aiming that by 2018, more than half of the payments will tie up to the quality of care the doctors provide. The alternative payment method is when doctors are paid based on quality care, where their performance, as well as patient experience, outcomes and readmission rates are also considered, and not just up to the services rendered to the patient.

Health care costs are oftentimes on the rise. They tend to get abused with overcharges for every pill, every service and even every Kleenex box provided to hospital patients, as documented by journalist and lawyer Steven Brill and others, who found non-profit hospitals to be among the most profitable “businesses.”

As these health care payment methods and programs are still new, there is still limited evidence the results will be sufficient and will have lots of savings, though they could surface along the way. The U.S. administration is also pondering on how to encourage the participation of providers in the Obamacare programs. It plans to expand participation on the new payment method by 30 and 50 percent, in 2016 and 2018, respectively.

Though most healthcare industry leaders are on board for the Obamacare change, some are still cautious and waiting for more details. The latter will check if the incentives they will receive for joining will be worth the potential financial risks.

Gauging quality is another concern, as some express their frustration with the way it is measured in the current models, which pay is based on performance. While health care professionals want to know how it is defined and who the decision-makers will be, patients fear that some city doctors, especially the specialists and surgeons, will get out of the Medicare network, which is already starting to happen.

The U.S. president also proposes to prohibit deals with prescription and brand name drug makers as he said, they delay the marketing of inexpensive generic medications. According to Mr. Obama, this will save Medicaid and Medicare about $11 billion over 10 years.

The extension of the Obamacare program will also be paid by increasing the taxes for tobacco. White House said this will help reduce smoking, especially among youths, and save lives.

For the patients, Obamacare’s new payment method for quality health care means better care at a lower cost, theoretically. Though it still needs time to prove it will yield the planned advantageous results.

By Judith Aparri

The Fiscal Times
ABC News
The Westside Story

Photo courtesy of Pollobarba – Flickr License

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