It's Time for Value Based Payment in Otolaryngology

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Its Time for Value Based Payment in
Otolaryngology
The Affordable Care Act comes as a boon for all
Americans as it helps them in accessing quality
healthcare at affordable costs. Although it is
the duty of Primary Care Physicians (PCPs) and
physicians in other specialties like
ENT/Otolaryngology to ensure that everyone is
able to access healthcare at low costs, the
ACA-based payment models may not be quite
favorable. Most of the physicians are bent on
shifting their reimbursement models and managing
the financial aspects of their practices poses a
real challenge. ENT revenue management will
focus on the shift from fee-for-service (FFS) to
value-based payment, which will certainly turn
out to be quite dramatic. The need of the hour is
for the physicians to understand payment reform
and make necessary plans to adapt to the new
conditions. ENT billing services like all others
know that ENT physicians need high productivity
along with better value. However, physicians
cannot afford to be paid less as cost savings
does not mean cost-cutting but better efficiency
with a reduction in duplication of services will
certainly benefit most of the physicians who are
still adjusting themselves to the new learning
curve. It is all about sharing risks and not
ignoring the need to share the savings as well,
which is the focus of new models including ACOs
(accountable care organizations). That is
probably why more and more private players are
opting to enter into contracts that are similar
to ACO ones.
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Its Time for Value Based Payment in
Otolaryngology
However, for small practitioners and those who
practice on their own (solo), pay-for-performance
models may not be the answer to value-based
reimbursement. ENT revenue management
experts feel that it is better for small
practices to collect and evaluate their own
outcomes. With the country being dotted
prominently with small practices, it is not easy
to find administrative mechanisms that are
applicable to all these small practices because
small practices are more proactive than
reactive. The ENT billing guide based on Pay for
performance models are primarily meant to
reimburse physicians on clinical and cost-saving
effects rather than for services rendered and
procedures carried out. PCPs are not on a mission
to help patients deal with their chronic maladies
and avoid hospitalization whenever possible and
do not prescribe a string of tests that are quite
unnecessary, nor do they prescribe branded drugs
that are expensive. This leads to overall
savings in healthcare. Pay for performance models
ensure that physicians get their due rewards if
they monitor how they have been keeping patient
care at cost-effective levels.
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Its Time for Value Based Payment in
Otolaryngology
Although there is an emphasis to persuade
physicians to adopt these payment models, most of
the physicians and small practice owners are not
very sure how well it will suit their size and
level. Until very recently ENT and other primary
care physicians have had only paltry earnings
based on performance measures as per the
physician compensation and production survey
conducted by the Medical Group Management
Association (MGMA). Experts are of the view that
physicians should not receive more than 10 of
their salaries on a performance metrics basis. In
order to develop working pay for performance
models, it is important to track clinical data in
order to track and reward quality patient
management. Medical Billers and Coders (MBC) is
a leading medical billing company providing
complete revenue cycle services. To know more
about our Otolaryngology billing and coding
services, contact us at info_at_medicalbillersandcode
rs.com/888-357-3226.