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Impact of A Shift Towards Value-Based Healthcare for Practice Owners

January 5, 2018

As a healthcare professional, it’s important to know that your patients are receiving the highest level of care that your practice can provide. This is one of the reasons for moving towards value-based healthcare as a way to offer affordable, personalized and coordinated healthcare regardless of physical location. While the benefit of value-based care for patients is clear, what is the impact on medical practices — and more importantly on the overall billing and revenue cycle? Reimbursement that is based on quality as opposed to quantity of care seems like a good move, but this shift has the potential to have a significant impact on medical billing practices. 

Difference Between Fee-for-Service and Value-Based Service

The fragmented payment network may soon be a thing of the past, with each procedure and test requiring separate coding and processing. Value-based service has the potential to transform the delivery of healthcare by changing the measurements for success. Instead of success being measured by the number of patients that are seen and the number of procedures completed, success under value-based service is measured by lowered hospital re-admissions, improvement of the overall health of the population, increased patient engagement and a reduction in adverse advents. Healthcare providers are then incentivized to focus on evidence-based medicine such as upgraded information technology, data analytics and more in order to receive payment for their services. Patients receive more comprehensive and consolidated care with all healthcare providers focused on positive and healthy outcomes and less need to focus on billing for additional procedures or getting new insurance approvals before care can be administered.

Fundamental Shift in Healthcare

While the cost for providing a more all-inclusive care to patients may increase in the short-term, several states such as North Carolina have proven that value-based care presents a long-term solution that is more cost-effective for healthcare providers and gives added peace of mind to patients. A team-based approach to care allows each individual to focus on their personal strengths, while leveraging the knowledge and experience of others on the care team. This is made possible through consolidated healthcare IT and digitally integrated networks and a single, secure electronic health record. Having a single medical billing partner allows practice leaders to reduce the cost of changes, ensure compliance with generally accepted standards and boost overall patient revenue. 

Effect on Medical Billing Services

Improved clinical outcomes for patients can mean a variety of different things, and some practices may find it difficult to quantify gains in this new paradigm. There’s a possibility that practice profits will drop off a bit as providers determine how to handle the rigorous reporting requirements and transition to the new requirements. Some medical billing services provide coding, while others require that the practice provides the requisite procedure codes and modifiers. Under value-based healthcare, the responsibility for patient outcome reporting generally falls to the practice — and not to the billing partner. However, billing providers may be able to offer advice and training to practice leaders as they navigate the required changes to paperwork and measurement philosophies. 

Is value-based healthcare right for you? Contact M-Scribe today at 888-727-4234 or via email to to discuss the various options available for medical billing and services to support this type of shift. Our professionals are extremely knowledgeable and services are platform agnostic — working with a variety of different billing software services. 

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