New payment models should reward quality
from Medical Economics
The current reimbursement structure contains many issues relating to the submission and payment of claims. Many providers feel they need to up-code to maximize revenue or down-code for fear of having a claim denied. Contradictory business goals have twisted this system into a payer versus provider tug-of-war, with patient care sometimes leveraged as a bargaining chip. Instituting quality metrics is a must to ensure that the patient remains at the center of this equation. This hybrid reimbursement model might be the most viable option for easily modifying the existing payment system while integrating quality care metrics and reducing costs.
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