The future of reimbursement

Inception of the Affordable Care Act increased the ‘velocity’ of the shift toward value based services.  Federal government programs are at least marginally incentivizing medical groups to provide care that falls within metrics the government believes indicative of good clinical practice.  Combined with other factors, the move to value has also increased consolidation of medical providers into larger groups within larger health systems.  That said, we have yet to see a new way of providing service that bends the cost curve over time.

If indeed a health system or large group is committed to value-based reimbursement, then it logically follows the group should not devote resources to support and maintain an internal billing function.  Billing takes certain expertise, time, and critical infrastructure to support, which resources would be better devoted to the move to value-based reimbursement.  Outsourcing also means the billing company, as opposed to the provider, has to balance the staffing requirements as the fee-for-service billing component of the practice diminishes.

While we may take issue with the view that most all clinical services will shift to a value reimbursement model, the current environment is one that argues for outsourced medical billing.

Whatever the next steps in medicine, we see a future that includes more cash-based medical practices, or a combination of cash- and insurance- based practice.  This structure also supports outsourced billing, as these practices should be running ‘thin’ on administrative overhead.  Ever-increasing sophistication of office support software will provide creative practice opportunities, especially for clinicians who want to balance life and medicine.