Essay On Medical Reimbursement

Outpatient Payments Philosophy As CMS dictates the nature of medical reimbursement, the adjustments made by CMS to outpatient payment models have drastic effects, many of which are often unintentional. Cost efficiency clearly finds itself on the top of the United States healthcare priority list, therefore placing extreme pressure on CMS to somehow find a “better” way to pay for care. The definition of “better” relies on not only causal relationships of care effectiveness, but also on simple morality of ensuring this payment model encourages the best possible setting for care. Currently, patients find themselves receiving a large amount of their medical services within the hospital outpatient setting, mainly utilizing the Outpatient Prospective Payment System (OPPS). With hospital services grouped into

PCMHs are showing slow improvements in patient satisfaction, overall quality, patient outcomes, and cost-effectiveness (Stockbridge et All, 2014). Although these improvements are not record-breaking, this concept shows how unclear the future of healthcare delivery actually is as well as driving policymakers to understand our current reimbursement methodology isn’t exactly adequate. With the Comprehensive Primary Care (CPC) initiative, CMS continues to demand further EHR implementation as well as offering bonus payments for providers who can document care coordination and patient outcome improvements. The difficulty remains, there is no proper way to do this, therefore a “One Size Fits All” PCMH is yet to exist, let alone a payment model encouraged by CMS. As hospitals struggle to maintain fiscal sustainability, they also lack a clear pathway into the future to implement organizational changes, as the future of CMS reimbursement is entirely