Providers are paid for seeing patients regardless of clinical outcome. As a result, each time a patient has a doctor’s appointment, a hospital stay, or a surgical consultation, the patient or third-party payers (insurance companies and government agencies) are billed for each visit, procedure, test, treatment, or other health-care service provided. Under this model, primary health care professionals are paid per person, per visit with a separate fee charged for each service provided to the patient. The conventional payment model of the American healthcare system-the FFS model-has been in place for centuries. The Current Healthcare Reimbursement System reflects challenges with the FFS model in light of rising industry costs, the shift to value-based care, and the new reimbursement models that healthcare companies are increasingly implementing under the value-based care framework.
The current health care reimbursement system in the U.S. Although the shift to a new value-based system will not occur overnight, health care companies should be equipped to manage care under evolving payment models. The goal behind this legislation and other health care reform measures introduced by Congress, government agencies, and private providers, is to move toward value‑based payment approaches in which providers are incentivized to provide high-quality service in the lowest cost setting. This legislation, the Affordable Care Act, which incorporated a number of initiatives promoting more value-based care, recognized that the traditional FFS model is inherently inefficient because providers are paid every time they provide a service, so the incentive is to provide more services. But the health care payment system has slowly evolved over the past few decades and at an accelerated pace since the passage of health care reform legislation in 2010. health care providers have been reimbursed on a fee-for-service (“FFS”) basis.
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