Healthcare Financial News

Two-thirds of health leaders, including government and private payers from 20 different countries, see problems with their current payment system, and they are exploring new payment models that use incentives to better balance access, quality, efficiency, and demand, according to a report published June 23 by PricewaterhouseCoopers’ Health Research Institute. The report, entitled You Get What You Pay For: A Global Look at Balancing Demand, Quality and Efficiency in Healthcare Payment Reform, provides a comprehensive overview of how payment models are changing in different countries, lessons learned from the experiences of other health systems, and findings of a survey of 200 health industry executives including government payers, private payers, hospital executives, and physicians.

Among other findings in the report, case-based prospective payment that groups reimbursement rates into diagnosis-related groups is the emerging standard for hospital payment, having proven to improve efficiencies. This type of hospital reimbursement already has been adopted by 70 percent of countries within the Organisation for Economic Cooperation and Development. Also, reimbursement to general practitioners and primary care physicians is far more varied among different countries and regions than reimbursement to hospitals. Models that integrate hospital and physician payment have proven best at creating mutually aligned incentives. Download the report.

People with psychiatric illnesses, including children, who are admitted to the hospital from the emergency department (ED) can wait 24 hours or longer for an inpatient bed, principally because of a lack of psychiatric beds. The findings of a survey of ED directors were reported June 18 by the American College of Emergency Physicians.

Of the 328 ED directors who responded to the survey, almost 80 percent said their hospital boards psychiatric patients in the ED. Thirty percent said their hospitals board psychiatric patients between eight and 24 hours, and more than one-quarter said that their hospitals board children with psychiatric illnesses for that long.

The main reasons given for boarding of psychiatric patients in the ED are the lack of in-house inpatient psychiatric beds, and either absence or inability of any facility to accept transfers of these patients. Sixty percent of respondents said their ED does not have a dedicated area for psychiatric patients. Read the report summary.