Only three percent of respondents believe their organization is highly prepared to make the pay-for-value transition, according to the findings of the 2016 HIMSS Cost Accounting Survey. The survey reflects the insights of 102 executives and finance professionals from an array of U.S. healthcare provider organizations. examines the approach healthcare providers are pursuing as they manage the changing payment landscape.
The transition from fee-for-service to pay-for-value has been referred to as one of the greatest financial challenges the U.S. healthcare system currently faces. Although this change is expected to happen over an extended period of time, CMS has announced aggressive goals for making the move with Medicare providers and hospitals. This requires healthcare providers to effectively navigate the challenges posed by a payment model that requires sharing and analyzing of data in ways that fee-for service and its legacy revenue cycle management systems and business processes never contemplated.
The awareness of these challenges associated with a pay-for-value transition varies by market. With approximately half of the survey respondents representing an organization participating in an alternative payment model, those serving an urban market (69 percent serving both urban and rural communities; 48 percent exclusively urban) were more likely to participate in alternative payment models than those exclusively serving rural markets (31 percent).
Many healthcare organizations have a formal process for determining healthcare costs, but only 39 percent regularly review those costs to ensure their information is current. Providers use an array of factors when determining service prices with profit margin necessary to maintain financial health and actual cost to deliver the care emerging as the most important factors. But, less than one-third of respondents have the ability to evaluate these costs in an automated fashion even though many have plans to expand the price transparency efforts
Top 3 Needs in Transitioning to a Value-based Payment System
The survey asked respondents to rank their organization’s readiness to move from a fee-for-service to value-based payment model, respondents indicated that the top areas of need were:
- Tools to track and evaluate quality of care;
- Better communication between disparate providers; and
- Consistent definition of quality by specific type of disease.
To download the complete 2016 HIMSS Cost Accounting Survey, please visit: http://www.himss.org/2016-cost-accounting-survey
