At the core of healthcare payment reform is the issue of fee-for-service as the basis for paying the delivery of patient care. Whether expressed as visits, procedures, sessions, treatments or units, there is direct correlation with the cost of care and the volume of care delivered. For providers, this means the more care delivered the more payment received. Many believe that if a little care is good, more is better and as long as someone was paying for care without questioning its effectiveness in accomplishing its intent, all is well.
Enter economic reality that the healthcare costs of this country exceed any other and there appears the benefit of all that spending does not make us a healthier nation. With limited money to pay for care everyone is asking, “How much and which care is enough?”
Treatment is controversial not because it is ineffective, but because we simply don’t know how to determine who will benefit from each and who will not. Each likely has the potential to provide benefit, but only for certain patients. We just don’t know how to determine who they are.
As long as we continue to reimburse healthcare using a fee-for-service, (e.g., volume-driven, reimbursement system)we will not substantially improve the quality of care. This system offers providers no incentive to improve their outcomes nor to find innovative ways to select patients better. Who cares if the patient will benefit or not, if reimbursement is the same either way?