By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    healthcare cybersecurity
    4 Helpful Tips on How to Protect Your Medical Practice Against Cyber Attacks
    October 24, 2021
    Health Check Diagnosis Medical Condition Analysis Concept
    6 Health Woes With Online Remedies
    January 19, 2022
    Eight Things Men Should Know About the Male Menopause
    Eight Things Men Should Know About the Male Menopause
    April 24, 2022
    Latest News
    Beyond Nutrition: Everyday Foods That Support Whole-Body Health
    June 15, 2025
    The Wide-Ranging Benefits of Magnesium Supplements
    June 11, 2025
    The Best Home Remedies for Migraines
    June 5, 2025
    The Hidden Impact Of Stress On Your Body’s Alignment And Balance
    May 22, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    healthy nursing school habits
    Healthy Habits for Nursing Student Nursing School Students
    May 24, 2024
    High Deductables
    High-Deductible Insurance and Rising Bad Debt
    July 24, 2015
    How People Are Taking Advantage of Health Deals in the Recent Recession
    February 5, 2021
    Latest News
    Top HIPAA-Compliant Messaging Apps for Healthcare Teams
    June 25, 2025
    When Healthcare Ends, the Legal Process Begins: What Families Should Know About Probate and Medical Estates
    June 20, 2025
    Preventing Contamination In Healthcare Facilities Starts With Hygiene
    June 15, 2025
    Strengthening Healthcare Systems Through Clinical and Administrative Career Development
    June 13, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: 5 Trends in Healthcare Reimbursement
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Business > Finance > 5 Trends in Healthcare Reimbursement
BusinessFinanceHospital Administration

5 Trends in Healthcare Reimbursement

Abby Norman
Last updated: September 24, 2014 8:00 am
Abby Norman
Share
9 Min Read
Healthcare Reimbursement
SHARE

Healthcare ReimbursementThe subject of physician compensation is a hot one as of late. With all the changes in the financial sector of healthcare, and the push to save money, there has likewise been a focus on how- and how much- physicians are being compensated.

Contents
ACOs | Healthcare ReimbursementNo More Fee-For-Service | Healthcare ReimbursementProspective Payments, or, “Bundled Payments” | Healthcare ReimbursementMedicare Advantage Plans | Healthcare ReimbursementTechnology | Healthcare Reimbursement

Healthcare ReimbursementThe subject of physician compensation is a hot one as of late. With all the changes in the financial sector of healthcare, and the push to save money, there has likewise been a focus on how- and how much- physicians are being compensated.

ACOs | Healthcare Reimbursement

A major change that has already begun to take place in many healthcare systems nationwide is Accountable Care Organizations (ACOs). While it’s likely too soon to know if they will work long term, in theory they will reduce the tendency of ‘silos’ in healthcare and lead to better coordination of patient care. Ultimately, these changes will usher in more cost savings- healthier patients will stay out of the hospital. While it might seem counterintuitive – how will doctors make money if their patients are healthy? – the reality is, even though the US is spending around 17% of the GDP on healthcare, population health measures don’t support the theory that spending more money means healthier patients – in fact, compared to other developed nations, our patients aren’t very healthy at all.

No More Fee-For-Service | Healthcare Reimbursement

The traditional payment model is slowly but surely fading into the background of healthcare history and making way for new models – but slowly is the operative term here. A solid percentage of healthcare providers are still operating under the traditional model – where providers are paid for the tests or procedures ordered regardless of their pertinence to the patient – and therefore healthcare spending continues to spiral. Under this model, it isn’t profitable for physicians if their patients are healthy and stay out of the hospital. Because we’ve operated under this model for so long, this assumption remains and it has informed the overall structure of our care models for several decades. With more and more healthcare organizations moving away from this model, however, sooner or later we’re likely to see a shift not only in payment – but paradigm. 

More Read

The Outcomes That Matter To Patients
The Outcomes That Matter to Patients
Jumping into Health Care Social Media
The ABCs of Specialty Pharmacy
Web-Based Patient Engagement Lowers Anxiety for First-Time Colonoscopy Patients
Reining in Avoidable Readmissions

Prospective Payments, or, “Bundled Payments” | Healthcare Reimbursement

Another way that payers are trying to leave fee-for-service models of payment behind is through the use of “bundled payments.” In this model, providers receive money up front for the cost of a single episode of care. In more specialized areas, where the cost is likely to be more or less the same for any patient undergoing a standardized treatment or procedure, this method would make sense. But for more general and, perhaps, complex patients -such as seen in primary care- bundled payments may not work.

Medicare Advantage Plans | Healthcare Reimbursement

For many Americans, Medicare is the only kind of healthcare coverage they have – without it, they would go uninsured. Many who are just over the threshold for being eligible, as a result of these standards, do go uninsured because they cannot afford private insurance and are not employed by a company that offers benefits. Medicare has begun contracting with private insurance plans to offer coverage to its beneficiaries through a plan they are calling Medicare Advantage. Through this plan, beneficiaries will receive coverage so long as they agree to stick to a certain, predefined network of healthcare providers. The predefined network isn’t altogether arbitrary and, to be part of Medicare’s network, the hospitals and providers much submit quarterly quality measures. Medicare then assesses their performance and rates them – using stars from 1-5 to denote quality (not unlike how restaurants are rated). Participants within the plan, then, are privy to some transparency about the hospital where they receive treatment. This model has provided many with a lot of hope about healthcare’s future – but currently, though it shows promise, most Medicare beneficiaries are still opting for traditional fee-for-service model plans.

Technology | Healthcare Reimbursement

One of the fastest growing industries within the healthcare industry is technology. This is reflected on a national level, where technology continues to be the driving force behind everything from health, to education, to car manufacturing. The revolving door of new technology (think about how frequently Apple puts out a new product, or new phone) is intense for any industry, but perhaps healthcare has the most to lose if they resist the opportunities to integrate. A major concern for the industry at the moment is coordination of care – and technology is the force that will allow this dream to become a reality. Utilizing it properly to achieve these outcomes, however, is no simple task. Electronic medical records are theoretically a dream – but in practice, they are often clunky and are much harder for the older generation of physicians to embrace. New doctors, who are never without their tablets and smartphones, are willing to integrate new technology but many have grown increasingly frustrated with the industry’s stubborn nature. For this reason, it may be hard to keep healthcare desirable to the next generation; they don’t want to find themselves trapped in a stagnant industry.

For patients, too, the advent of various technologies in the last two decades has allowed them to more actively participate in care – sometimes much to their physician’s chagrin. While having access to unlimited health information via Google may be helpful to some, for many patients and their doctors it is a bone of contention. While some patients may have the health literacy necessary to parse out this information and turn it into a useful dialog with their physician, the majority do not. The average American reads at a middle school level, meaning that even basic medical jargon might as well be a foreign language. But even for health literate patients, technology has allowed them to almost demand to have more control over their care. Doctors are no longer necessarily the gatekeepers of information – and many of them are displeased at being displaced and are not chomping at the bit to welcome patients in partnership.

While many of these new changes are exciting and have promise for revamping our ailing healthcare system, it will also require enormous leaps of faith from not just payers and hospitals, but providers and patients. The lines between administration and clinical practice, to patients and families are becoming more and more blurred as the industry evolves – and physicians especially are finding themselves stuck in the middle of frazzled administrators with lots of demands and patients who are older and sicker than ever before. When you put it like that, it makes you think doctors aren’t paid nearly enough to be that stressed.

Share This Article
Facebook Copy Link Print
Share
By Abby Norman
My name is Abby Norman and I am a healthcare blogger. With over 10 years of experience in the medical field, I have developed a passion for helping others understand the complexities of healthcare.

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

women dental care
What Is a Smile Makeover and How Much Does It Cost?
Dental health
June 30, 2025
HIPAA-Compliant Messaging Apps
Top HIPAA-Compliant Messaging Apps for Healthcare Teams
Global Healthcare Policy & Law Technology
June 25, 2025
recovering from injury
Rebuilding After Injury: Path to Physical and Emotional Recovery
News
June 22, 2025
scientist using microscope
When Healthcare Ends, the Legal Process Begins: What Families Should Know About Probate and Medical Estates
Global Healthcare
June 18, 2025

You Might also Like

healthcare jobs happy team
BusinessNews

Healthcare Jobs – Fastest Growing Job Sector in Next Decade

February 11, 2012
medical billing
BusinessFinance

15 Minutes Could Save You…Nothing in Medical Bills

March 12, 2014
big data in healthcare
BusinesseHealthHealth ReformMedical RecordsPolicy & Law

Big Data = Big Savings in Healthcare

March 7, 2014

More Facility Fee Dysfunction: Infused Drugs

January 30, 2013
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?