Why is the transition to value-based payments moving so slowly? The reasons: economics and a traditional industrial mindset that values volume. For example, the following factors support fee-for-service (FFS) models:
- Health plans have legacy claims payment systems that are structured for receipt of a claim for a specific service and either a denial or a payment.
- The provider billing support services industry, such as coding, bill preparation, and clearinghouses, are structured to comply with the payers’ legacy claims systems, including government payers.
- Legislative and reporting agencies are still interested in receiving, analyzing, and reporting on services, costs, and trends based on discrete units of care that can be best accomplished through claims submission using established coding systems, such as CPT and ICD10.
- The explosion of data submission requirements in the last 40 years (e.g., meaningful use, CPT, HCPCS level 3 information only codes, ICD-10) are aimed at further categorizing, counting, and analyzing discrete services.
See related article: How to Really Know Your Payment Rates