The thought leaders at Staff Care have released a new white paper exploring hospital compensation and healthcare spending trends in the United States, encompassing today's healthcare environment as well as the preceding decades that have shaped it.
"Physician and Hospital Reimbursement: from 'Lodge Medicine' to MIPS" traces how compensation for physician and hospital services has evolved over the past decades, and examines the "profound ways in which new reimbursement models are transforming the healthcare delivery system in today’s era of healthcare reform," as the authors put it.
"The white paper begins with a look at early, direct compensation methods and includes an examination of emerging compensation models such as the Merit-Based Incentive Payment System (MIPS) mandated by the 2015 Medicare Access and CHIP Authorization Act (MAPRA). It concludes with a discussion of how changing reimbursement methods may affect physician practice patterns and physician staffing."
Healthcare Spending Trends from the 19th Century through the ACA and MACRA
The white paper's look at the history of physician compensation and healthcare spending is comprehensive, beginning in the earliest years of American history when there was no formal healthcare industry, and continuing through the 19th and 20th Centuries as physician compensation went through phases including payment from fraternal societies like the Loyal Order of the Moose in what was known as “lodge medicine” and the Flexner Report of 1910, which transformed the way professional medicine was practiced in the U.S., ushering in the modern era.
The overview continues with a look at how hospital utilization and receipts plummeted during the Great Depression, and the slow implementation of a national healthcare insurance system in the post-War decades. All of which, of course, culminates in the Affordable Care Act (ACA) of 2010, as a result of which "11.4 million people have enrolled in insurance plans offered through the state insurance exchanges" that the ACA established.
"In addition, five million Americans have enrolled in Medicaid since 2012, after Medicaid eligibility was expanded by the ACA. Medicaid payment rates to physicians were temporarily increased to Medicare levels, though this equivalence ended in January 2015.
"According to Gallup, all of this has resulted in a drop in the rate of uninsured adults from 18% in 2013 to 11.4% in 2015, the lowest uninsured rate on record in the history of the United States."
The white paper also looks at the implications of the Medicare Access and CHIP Reauthorization Act (MACRA) of April 16, 2015, "another major adjustment to physician reimbursement" that will increase Medicare payments by 0.5% a year from July 2015 to December 2018. And, of course, any truly comprehensive look at healthcare spending also looks to the future — as this white paper does, with explorations of post-ACA laws going into effect in the next half-decade.
"The reality is that reimbursement in healthcare is dramatically more convoluted and arcane than in almost any other sector of the economy, in which professionals or businesses generally determine their price, submit a bill to the recipient of the goods or services provided, and are paid by the recipient the amount they invoiced," the authors conclude. "The ability of healthcare administrators and physicians to understand and adapt to the vagaries of reimbursement will largely determine their professional satisfaction and success."
Download a copy of the new Staff Care white paper here.
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