Will Medicare Changes Result in Better Quality?

September 3, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt, Medicare

As the price of health care in America keeps rising, you may be among those that are frustrated by the kind of generic approach taken by  health insurance companies and government entitlement programs. The traditional fee-for-service format of health care reimbursement means that the best hospitals and doctor’s offices don’t get rewarded and the lower performing offices don’t have consequences. But, this is all likely to change with new Medicare rules that are slated to pursue more of a ‘meritocracy’ in the way that health care dollars get paid out.

New Medicare Rules

Reports from the Centers for Medicare and Medicaid Services show that Medicare is going to begin making some changes in the way that it reimburses health care providers starting late this year. In what Medicare officials call a ‘value-based purchasing’ program, Medicare will consider various aspects of a provider’s operations in setting the reimbursement rates for that particular office. Key factors will include observation of outcomes, or in other words, whether the procedures and services performed at an office actually help patients to recover from illnesses and improve quality of life.

Responses to the Changes

For you, this represents a major change and a big potential edge in making sure you get what you deserve for the money, especially when you have out of pocket expenses. On the downside, though, some providers are arguing that hospitals and offices in rural areas, or those with other significant disadvantages, may be punished unfairly. It all has to do with the careful calibrations that Medicare officials will use in attempt to measure rather vague metrics like customer satisfaction, quality of outcomes, and much more.

While it may not be a perfect system, most consumer advocates would agree that the new Medicare rules are a step in the right direction, toward an overall reform of a health care system where prices are not only sky-high for the average family, but are often not representative of what patients receive. We’ve often talked about how American families face medical bankruptcy because of medical bills that may be hugely inflated or that may include other gross errors. Broad-based reform addresses these kinds of inequity and pushes toward a system where more Americans can afford the health care that they receive. It’s important to stay vigilant about your finances and be your own medical and financial advocate in a system that often puts the burden of action on the patient, rather than the provider, the insurer or the government payer.

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