Guide for the Perplexed

It is clear that the way that health care gets paid for in the United States is undergoing rapid change. What is not at all clear, at least not to me, is exactly what the payment model will look like in the future, or how far off that future is. Although everybody agrees with Yogi’s assessment that “it’s tough to make predictions, especially about the future,” this exercise seems particularly challenging because of the wide variety of “alternative payment models,” likelihood that they will co-exist, and the prevalence of regional differences.

It is because of this complexity that I found a recent paper in the Annals of Internal Medicine to be helpful. It is a simple “field guide” to different payment models that starts with distinguishing the “unit of payment” (e.g., per unit of time, per episode of care, per beneficiary, etc.) and then uses these to review efforts at payment reform over time.

I found this helpful in keeping all of these things straight in my head, and I liked the way it started from “first principles.” I think it is worth the read.

What do you think?

2 thoughts on “Guide for the Perplexed

  1. Anything that would give anybody a clue is wonderful. It’s not just the Insurance payment schedule and guidelines, it’s bookkeepers, coders, etc. and their ability to be accurate. Personally, I think that doctors should be able to charge interest or late fees from insurance companies, if a claim isn’t processed and paid in a timely manner. Everyone else has to pay.

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