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引爆点是一种趋势或想法跨越阈值并在人群中迅速传播的时刻. It is often when an unstoppable effect or change takes place. When we eventually emerge from the COVID-19 pandemic, 我们的医疗保健行业将处于支付改革的临界点:我们会回到现状吗? Or will the industry finally accelerate toward more meaningful value-based care?
全球流行病带来的使用率下降迫使云顶集团40011官网和其他提供机构更密切地关注其不断萎缩的利润,并寻找新的方式来吸引新的收入(提示:按云顶集团收费的支付模式不是答案)。. 医疗机构需要创造性地思考,提供改善患者治疗效果的云顶集团,并为社区带来真正的价值.
我们预计,新兴的医疗保健市场将更快地转向以价值为基础的护理. 尽管COVID-19可能被证明是一个转折点,但其他几个驱动因素正在改变这个行业. 这篇博文将强调那些关键的市场力量和其他将加速这种演变的动态.
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Site-Neutral Policies
在过去的几年里,提供病人云顶集团的护理地点发生了重大变化. CMS has increasingly removed procedures from the inpatient-only list, with nearly 300 procedures coming off the list at the first of this year alone. Patients have increasingly preferred care outside of the hospital setting, 这一趋势在大流行之后只会加剧,因为患者希望尽量减少与病毒的接触. Outpatient-based procedures are less invasive, do not require overnight stays, and typically involve a quicker recovery time.
进一步, 将护理从住院病人转移到门诊病人,从门诊病人转移到asc,可显著节省费用. 政府和商业付款人都实施了网站中立的支付政策,无论设置如何,都支付一个标准费率. Providers are therefore incentivized to provide care in these lower-cost settings. We have seen site-neutral payment policies implemented across several service lines, including orthopedics and cardiology.
Aging Population
The US population is aging; by 2030, all baby boomers will be older than age 65. 这将扩大老年人口的规模,以至于每五个美国人中就有一个到了退休年龄. 进一步, this means that older people are projected to outnumber children for the first time in US history.
What does this mean for the healthcare industry? Older populations usually consume more healthcare services compared to children and adults. We can expect an increase in prevalence of chronic disease, cancer, and other illnesses. As a result, 这些患者将需要集中的护理管理云顶集团,并可能从高接触项目中受益.
Value-based care is built on care coordination and close management of patients; specifically, these services can reduce unnecessary ED visits or admissions, which drive up the total cost of caring for elderly patients. 通过实施奖励价值而非数量的替代支付模式(APMs),提供机构将能够更好地改善其患者群体和整个社区的健康状况.
National Physician Shortage
再加上人口老龄化,美国也面临着全国性的云顶集团40011官网短缺问题. 美国医学院协会(AAMC)最近的一份报告预测,我们的国家将面临一个 shortage of up to 139,000 physicians by 2033. 今天,当我们在第一线动员起来抗击这一流行病时,云顶集团40011官网劳动力短缺的感觉更加强烈.
To counteract this trend, health systems and other provider organizations must get creative in care delivery; that is, they must build multifaceted care teams that include physician assistants, nurse practitioners, and other advanced practice providers (APPs). Fortunately, this strategy is highly conducive for value-based care, as it allows organizations to provide care at a lower cost.
Recently, several states have expanded the scope of practice for APPs. 22个州和哥伦比亚特区允许NPs在“全面实践环境”中发挥作用,” which includes evaluating patients, ordering and interpreting diagnostic tests, managing treatments, and prescribing medications. Other states—such as Oregon, California, 佛罗里达州已经立法取消对医师助理的限制性监管要求.
Digital Health Adoption
Over the past several months, 数字医疗迅速扩展,并进入了一个新时代,几乎所有的提供者组织都采用了某种形式的远程医疗或其他技术. Without a doubt, 在疫情最严重的时期,数字医疗的采用在保持患者可及性方面发挥了重要作用.
Recognizing the value associated with these tools, many health systems are looking to maintain and expand these services permanently. 远程保健使提供者能够以较低的成本和较少的障碍向患者提供护理. 患者监测工具允许提供者远程跟踪患者的生命体征,并在需要时进行干预. 患者门户网站和电子信息提供了全天和非工作时间的公开交流论坛. 这些好处都有助于建立健全的基于价值的护理战略,扩大患者的可及性,并进一步支持护理管理战略.
Federal Government Initiatives
In the last decade, there has been strong support from the federal government to transition to APMs, both on a voluntary and mandatory basis. 我们发现,商业支付方可能会效仿,因为他们也专注于成本管理. Therefore, 我们预计来自政府和商业支付者的压力将影响医疗系统的整个支付者组合(不仅仅是医疗保险或医疗补助患者)。.
值得注意的是, CMS has prioritized developing and expanding programs that focus on high-cost populations, such as those with chronic illness. 这些患者群体可以通过促进护理协调的项目得到更好的管理, frequent touch points, and a highly engaged care team.
- The Primary Care First Model began on January 1, 2021, 作为一种支持和激励提供者为所有患者提供强化初级保健的方式, including those with complex and chronic illnesses.
- Additionally, CMS has also focused efforts on procedures with high variability in cost. CMS recently announced the Radiation Oncology (RO) model, 这是一项强制性计划,将要求指定邮政编码的所有放射治疗提供者通过病例率支付费用, instead of on a fee-for-service basis. By changing the way radiation therapy services are currently paid, CMS hopes providers will deliver higher-value radiation therapy care (e.g., fewer doses, if appropriate, thereby reducing total spend).
We expect that other similar programs built around these high-risk populations will be announced in the coming years; provider organizations will need to be ready to make changes to their processes and procedures to account for these new care models.
Final Thoughts
Admittedly, the transition to value has been slow over the past decade. 然而, there is no doubt we are on the verge of a tipping point, 随着市场的重大变化引发了创新,并重新点燃了对替代医疗的关注. 基于价值的付费模式的重要性可能会增加,因为现有的和新的市场力量将塑造当前和未来的行业.
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联系 UsPublished January 21, 2021