|Fee-For-Service, Capitation Facing Competition, Extinction
In one corner stands fee-for-service, in the other
capitation. Neither payment system is ideal. Fee-for-service benefits
the provider’s pocketbook often at the expense of patient care.
Full capitation raises the opposite concern – that
providers are put at full financial risk, and thus might withhold
needed patient services to maximize profits.
Policy makers are grappling with a compromise concept, episode-based payments (EBP), which is an idea gaining steam.
This in the current result of a new study,
"Episode-Based Payments: Charting a Course for Health Care Payment
Reform," conducted by researchers at the Center for Studying Health
EBP would bundle payment for some or all services
delivered to a patient for an episode of care for a specific condition
over a defined period, according to the study. For example, the care
received by an auto-accident victim from triage in the emergency
department through hospitalization, trauma surgery and rehabilitation
could comprise an episode.
Without dramatic reform of payment structures, payers
and patients can expect to experience continued rapid growth of
healthcare costs and little improvement in the quality or coordination
of care, the study said. But moving too rapidly with reforms that
bundle payments for all care delivered to a given patient can backfire
if the majority of providers are ill equipped to respond
EBP, if carefully developed, can serve as a bridge for
many providers between current fee-for-service structures and a future
that emphasizes care of whole patient populations, the study suggested.
Well-designed EBP system would encourage providers to improve
efficiency and quality of care.
Defining episodes of care, establishing payment rates
and identifying those providers who should receive payments are major
obstacles health policy makers will be grappling with to make EBP work,
the study concluded.
Address: Center for Studying Health System Change, 600 Maryland Ave. SW, #550, Washington DC 20024; (202) 484.5261, www.hschange.com.