Payers recognize a growing need for more comprehensive payment methodologies that adequately represent the true market cost of health services today.
As the healthcare industry undergoes unprecedented change, particularly in regard to payment reform, payers recognize a growing need for more comprehensive payment methodologies that adequately represent the true market cost of health services today.
Providers who have traditionally based their payment methodologies on a multiple of Medicare’s fee schedule are beginning to recognize inherent limitations in a Medicare-based schedule that can affect their bottom line. Luckily, many limitations can be addressed by integrating independent, market-based data into a payment schedule. For example:
To remain viable in this changing healthcare environment, payers of all types will need to make thoughtful, well-informed decisions about their reimbursement methods. Robust, reliable, and relevant data are the key to building a payment model that appropriately compensates healthcare providers.
Joel V. Brill, MD, is the medical director for FAIR Health, Inc., a national, independent, nonprofit corporation whose mission is to bring transparency to healthcare costs and health insurance information.