One Obamacare Benefit: Care Delivery Reform
President Obama’s signature Affordable Care Act (ACA) — better known as “Obamacare” — has suffered years of negative publicity and controversy, most of it warranted. But one beneficial aspect of the law almost universally missed in the public discussion is the law’s initiation of care delivery reform, whereby the prevailing “fee for service” care model is being phased out in favor of an ostensibly more efficient and affordable fixed fee model.
Health reform advocates of both parties — while vehemently disagreeing over the ACA’s health insurance expansion model — generally agree the current fee-for-service system creates perverse incentives for providers, who get paid according to the quantity and volume of the treatments they provide. Thus, “more” visits to the doctor in and of itself is supposed to result in better outcomes and higher quality.
Many physicians complain that the existing fee-for-service model turns their practices into assembly lines with mountains of paperwork, and not necessarily achieving the desired patient outcomes. More does not equal better, and the ACA is attempting incentivize quality and value over sheer volume of services performed. This should be applauded.
Under a new program within the ACA, participating providers will receive fixed monthly “bundled” fees for every patient, and bonuses for meeting a variety of stipulated quality goals. Therefore, if their patients stay healthier and require less-expensive care, doctors will share in the savings to Medicare, Medicaid or private insurers in the form of higher reimbursements.
The theory is that the new financial incentives will encourage more preemptive communication with patients, and a greater emphasis on prevention and wellness. Yes, Obamacare has largely been a disaster on many fronts, already debated and covered ad nauseam. But on a pure policy and reform basis, Republicans should give this new effort to supplant the failed, expensive fee-for-service care model with the fixed fee approach.
The beneficiaries may well be patients and taxpayers. What a rarity when it comes to government programs.