Question

Choose one trend for future reimbursement methodology that is pertinent to hospitals and describing the changing reimbursement including evidence of relevant journals or pertinent websites.

Answer 1

The one trend for future reimbursement methodology that is pertinent to hospitals is the change from volume to value. The changing reimbursement is taking place with an increased focus on an opportunity to innovate and to align incentives and ensure that benefits from the reimbursement methods are maximized in future.

Future reimbursement methodology will be based on value based methods, bundled payments and capitation. In case of value based methods providers will receive modified payments that will be based on actual performance which will be compared to a baseline. In case of bundled payments the payment for an inpatient stay and for the subsequent aftercare will be shared among all providers. In case of capitation a periodic payment will be made to providers and the risks for care will be shared between the provider and the payor.

Evidence of pertinent websites:

https://www.diamondhealth.com/what-we-do/Investor-Owned-Hospitals/future-reimbursement

https://cdn.ymaws.com/www.virginiachiropractic.org/resource/resmgr/imported/Insurance%20Payment%20Methodologies.pdf