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A Guide To Coding For Value-Based Care

Health care costs continue to increase, and various employers are looking for methods to reduce those expenses without sacrificing the quality of care their employees receive. Value-based care, or treatment provided in accordance with such agreements, has garnered a lot of interest because of its potential benefits. However, what exactly does “Value-Based Care” entail?

Under the Value-Based Care (VBC) model of health care delivery, hospitals, labs, doctors, nurses, and other providers receive reimbursement tied to the health outcomes and quality of care that patients experience. Some value-based contracts require providers to assume some of the financial risk from the health insurance company. Incentives for providing high-quality, efficient treatment can be earned in addition to negotiated fees.

Unlike the fee-for-service approach, in which clinicians are compensated for each individual medical care rendered, VBC instead pays for a set amount regardless of how many services are rendered. Both models can deliver high-quality medical attention, but value-based care (VBC) has the potential to reduce costs while simultaneously improving patients’ health.

We all know that healthcare is a major issue for the United States as a whole. In this article, we’ll go over the basics of VBC and show you how profee coding can help you save some money while improving your health.

The Fundamentals Of Value-Based Care

Providers are constantly looking for ways to enhance the patient experience while decreasing the cost of service, and this is directly related to the patient reimbursement model’s impact on patient satisfaction. The predominant payment model is the fee-for-service (FFS) system, which rewards doctors more for the quantity than the quality of their treatments.

Value-based care, on the other hand, aims to alter the conventional practice of providing medical attention to patients, with potential positive outcomes for all parties. Basics of Value-Based Care describes what value-based healthcare is, how it differs from standard compensation models, and why it’s beneficial for both your patients and your practice.

The Two Primary Model Categories

Accountable Care Organization (ACO): An ACO is a group of medical professionals (doctors, hospitals, and others) who have agreed to provide Medicare patients with coordinated care. If the ACO is able to deliver sufficient care and high-quality services that lower healthcare costs for patients, the network providers will split the savings under this value-based care model. In an ACO, everyone benefits from reduced costs if the care and services provided are high quality, but if they aren’t, providers in the network may have to pay Medicare back for falling short of expectations.

Bundled Payments: Patients can pay a single fee for all of the services they received during their care, regardless of how many different providers were involved in their treatment. All of the doctors, hospitals, and other facilities involved in the patient’s care get paid in one lump sum based on the final diagnosis and treatment plan. In the case of surgical procedures, for instance, CMS would pay the hospital, surgeon, and anesthesiologist as a unit based on past rates rather than for each individual service rendered. Providers in a bundled model can keep the money they save by providing services at prices lower than the combined pricing. However, the additional expenses must be paid for by them.

The Perks Of Value-Based Care

Healthier society: To improve public health, lower healthcare costs will allow more individuals to receive the necessary medical attention, leading to earlier detection and treatment of chronic diseases. Patients living with chronic conditions are encouraged to take better care of themselves since they no longer face the anxiety of potential financial consequences if they do not. They are more likely to get medical attention right away and take charge of their disease management if they have faith in the individualized plan put in place for them.

Lesser costs: Value-based care reduces spending because it discourages doctors from trying everything under the sun. Patients will save money since doctors won’t be incentivized to prescribe unnecessary services or treatments. Value-based care improves long-term outcomes by incentivizing providers to treat patients as individuals and find unique answers to their unique health problems.

Better patient experience: Patients will have a smoother experience with their care since clinicians, under a value-based approach, will be expected to maximize productivity and plan ahead for each patient encounter. It incentivizes them to get to the bottom of patients’ complaints rather than simply ordering a battery of tests that can be time-consuming, expensive, and inconvenient for the patients themselves. There is less of a focus on transactional care and more on developing a relationship with one’s doctor. Initial consultations allow doctors and nurses to get to know their patients and gain a more complete understanding of what brought them in. Because of this, patients have a better time while receiving care.

How Does VBC Help Financially?

Providers, patients, and insurance companies all have a vested interest in maintaining patients’ health and reducing costs because of VBC’s proactive, data-driven approach.

It’s no secret that preventing illness and treating it when it’s still in the early stages is more beneficial to individuals and more cost-effective for healthcare systems than waiting until it’s in a more advanced stage. Costs associated with chronic diseases that are managed effectively are lower than those associated with unmanaged conditions that worsen with time. Better administrative efficiency and lower costs can result from better care coordination and data exchange.

Value-Based Care Is A Game-Changer In The Healthcare Industry

The government is providing incentives to providers who switch to value-based care, which is increasing its popularity. More providers will likely make the switch to value-based care as a result of recently enacted legislation. The difficulty of keeping accurate records of the measures needed to establish ‘value’ in a value-based paradigm is a common complaint from practitioners.

In order to determine how much healthcare should cost, a healthcare provider must keep track of a wide variety of data, including but not limited to staffing and patient attendance records, clinical data, patient acuity information, and much more.

VBC Success Depends On Ecosystem-Wide Collaboration

The primary care physician typically serves as the team’s leader in VBC models. Nobody expects patients to figure out the healthcare system on their own. The care team is available to help them through each step of their treatment. The goals of care teams should be on preventing illness, promoting health, developing effective treatment plans, and coordinating the delivery of all necessary medical services for patients with chronic diseases.

Members of the multidisciplinary care team may include, but are not limited to, case managers, mental health professionals, social workers, pharmacists, dietitians, teachers, psychologists, health coaches, and executives. A patient’s health care team may include people who aren’t doctors or nurses but who still collaborate with those who are to determine and meet the patient’s unique medical requirements.

The goal is to get patients involved, find solutions to their problems, and improve their ability to take charge of their health.