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Is “value based care” truly the wave of the future?

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  • Is “value based care” truly the wave of the future?

    I am told frequently healthcare is moving towards value based care. How does this really look in the future? It seems hard to believe that fees paid for services could ever be completely eliminated. This idea of patients texting me to have care in home sounds like only increasing likelihood of physician burnout.

  • #2
    I think it is. Currently there is no other reasonable way to incentivize physicians to reduce costs without making everything a constant battle for authorization. They do that already, and costs are still skyrocketing.

    this is already happening with all sorts of new Medicare programs, bundled payments, and in some parts of the country for various specialties in addition to primary care.

    The current system under pays for cognitive services and drives the market towards overdoing certain procedures. The value-based care system will create other incentives, and it is not clear if in balance it will be worse or better.

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    • #3
      To me it means we will realize we spend(waste) a ton of money on completely fruitless work-ups, endeavors and treatments

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      • #4
        Probably not. More likely it is a rationale for insurers and administrators to pay physicians less for the work they perform.

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        • #5
          If they looked into malpractice reform and change how that's handled, they'd probably be surprised at how much money that would save. But Americans would need to change their mindset and be ok that the miss rate isn't going to be 0%.

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          • #6
            Would this create incentives to select for patients with higher personal health motivation? Will utilization of physician time increase under this model? I am told I need to share “risk” with my patient care base to be compensated for my contribution to the system. Some of these concepts seem outside of my direct manipulation.

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            • #7
              Here’s an idea: value based administration. Cut the administrators that don’t add value to the actual care provided, leave the few that do. That will cut “healthcare” spending rather quickly.

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              • #8
                Originally posted by Anne View Post
                Here’s an idea: value based administration. Cut the administrators that don’t add value to the actual care provided, leave the few that do. That will cut “healthcare” spending rather quickly.
                We're going to need to add 10 regular admins and 15 nursing admins to oversee this new idea.

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                • #9
                  Originally posted by CordMcNally View Post
                  If they looked into malpractice reform and change how that's handled, they'd probably be surprised at how much money that would save. But Americans would need to change their mindset and be ok that the miss rate isn't going to be 0%.
                  As a lawyer, I frequently have wondered how an “Affordable Care” Act could achieve affordability in healthcare without significant med mal reform.

                  Then again, I object to contracts of adhesion that require arbitration for utilities and other common consumer interactions. At the same time, I think that members of the plaintiffs’ bar should take in like kind as the members of a class.

                  If everyone gets a coupon for $500 off of MSRP at their local Chevy stealership or a $5 coupon off of their next month’s bill with DirecTV, then the attorneys who brought the lawsuit should get 30% of the total judgment value in these worthless coupons and rebates. 😈. Same non-transferability, same lack of ability to elect cash instead.

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                  • #10
                    Depends on who sets the topic and assigns the value….

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                    • #11
                      No.

                      Combination of employed docs that don’t want to work and hospitals not wanting them to utilize resources leads to horrible access and angry patients that can’t get care. It’s a total joke to me and eventually people will realize they’re paying 2k a month yet can’t see a doc for 6 months.

                      At some point someone will figure out how to create physician led mini hospitals (more services than your ASC) where physicians have skin in the game from a financial and administrative standpoint but backed by real money. It needs to stay independent from the national chains (HCA) so it can adjust to the local markets. If it provides transparency, access and lower costs than it stands a chance.

                      obviously I’m probably totally clueless on this but at some point someone will figure it out better than these evil not-for-profits (IHC) and for profit (hca) chains.

                      but it’s absolutely amazing to me how everything is driven by motivated docs. If they’re not working than no one is working. At some point it just doesn’t seem like it makes sense.

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                      • #12
                        Originally posted by Sundance View Post
                        but it’s absolutely amazing to me how everything is driven by motivated docs. If they’re not working than no one is working. At some point it just doesn’t seem like it makes sense.
                        It's absolutely amazing what being motivated does to people and the resultant care that patient's get. At least in the ED, a motivated doc, motivated nurses, and motivated techs can absolutely turn rooms over and keep patients happy. Unmotivated ones can absolutely kill ED throughput. The best ED docs understand what the rate limiting step is going to be for a particular patient and they address that off the bat.

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                        • #13
                          Several vertically integrated systems that essentially are capitated and value based internally -- Kaiser is a prime example.

                          Anne - you know at the VA we know that 20% does 80% of the work across the board, right?

                          Yes, VBC can work. It does take a bit more oversight and rewards proper work vs work the can just make you look busy, and not effective.

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                          • #14
                            I don’t know the answer. I’ve worked at the VA, Kaiser, and private practice. The answer is probably in the overlap of the Venn diagram of these models but who knows how to make that happen

                            ive seen specialists that don’t want to see a patient, and a cardiologist who would cath a dead donkey if given the chance.

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                            • #15
                              How does a society that rejected only paying for care that works as "death panels" go even further and pay only for care that works and is "valuable"? I don't think it's possible.

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