fee for service and patient portal are not compatible

by Prof. Alec Kohler 7 min read

All Fee-For-Service Providers | CMS

7 hours ago How do I remove the NextGen Enterprise patient portal from Compatibility View? Feb 11, 2022 · Messages between the patients and the healthcare provider can be shared over a Patient Portal system. This provides a platform for formal communication and keeps a record of all … >> Go To The Portal


Can co-opting physicians regulate fee-for-service (FFS)?

Co-opting physicians to regulate Fee-for-Service (FFS) payment is more feasible and simpler to administer than capitation, Diagnosis-Related Groups (DRGs) and pay-for-performance. The key lies in designing and revising the fee schedule, which not only defines and sets the fee for each item, but also the conditions of billing.

Is fee-for-service a good or bad practice?

There appears to be a general consensus that Fee-for-Service (FFS) payment is an evil practice leading to overprovision, inefficiency and uncontrollable health expenditures (1). The assumption is that FFS encourages physicians to deliver more and unnecessary services to maximize their income.

Is capitation the future of fee-for-service payment?

The Fee-For-Service (FFS) payment model has increasingly been seen as costly and cumbersome overall to providers. Medicare programs highlighted the need to transition to a quality-based payment model, which is Capitation.

Can a private hospital charge for a service not covered?

Moreover, private payment is not restricted to private facilities: publicly financed facilities may continue to charge patients for services not covered (extra-billing) or to charge more (balance billing), which will defeat the purpose of introducing DRGs or capitation.

Who isn't using patient portals and why?

Sixty-three percent reported not using a portal during the prior year. In multivariable analysis, we found that nonusers were more likely to be male, be on Medicaid, lack a regular provider, and have less than a college education, compared to users.

What are the disadvantages of patient portals?

Even though they should improve communication, there are also disadvantages to patient portals....Table of ContentsGetting Patients to Opt-In.Security Concerns.User Confusion.Alienation and Health Disparities.Extra Work for the Provider.Conclusion.

What are the different types of patient portals?

There are two main types of patient portals: a standalone system and an integrated service. Integrated patient portal software functionality usually comes as a part of an EMR system, an EHR system or practice management software. But at their most basic, they're simply web-based tools.

What should be included in a patient portal?

A robust patient portal should include the following features:Clinical summaries.Secure (HIPAA-compliant) messaging.Online bill pay.New patient registration.Ability to update demographic information.Prescription renewals and contact lens ordering.Appointment requests.Appointment reminders.More items...

What are the pros and cons of patient portal?

What are the Top Pros and Cons of Adopting Patient Portals?Pro: Better communication with chronically ill patients.Con: Healthcare data security concerns.Pro: More complete and accurate patient information.Con: Difficult patient buy-in.Pro: Increased patient ownership of their own care.

What is the most common barrier to the use of the patient portal?

Among nonadopters (n=2828), the most prevalent barrier to patient portal adoption was patient preference for in-person communication (1810/2828, 64.00%) (Table 2). The second most common barrier was no perceived need for the patient portal (1385/2828, 48.97%).

How much does IT cost to implement patient portal?

A patient portal app for the health care sector usually costs $12,500 to build. However, the total cost can be as low as $5,000 or as high as $20,000.

What is the purpose of a patient portal?

A patient portal is a secure online website that gives patients convenient, 24-hour access to personal health information from anywhere with an Internet connection. Using a secure username and password, patients can view health information such as: Recent doctor visits. Discharge summaries.

Who has the best patient portal?

Healthcare IT rating agency KLAS recently selected athenahealth's athenaCommunicator as the #1 patient portal, with a score of 91.8 on the most recent Best in KLAS awards . athenahealth's suite was also ranked #2 overall for practice sizes from 1-75 physicians.

What is the difference between personal health records and patient portals?

A patient portal is a type of personal health record (PHR) that is connected to an electronic health record (EHR) system. Patient portals provide a secure website through which patients can access their clinical data.

Is a PHR the same as a patient portal?

PHRs, EHRs and patient portals A PHR that is tied to an EHR is called a patient portal. In some but not all cases you can add information, such as home blood pressure readings, to your record via a patient portal.

What types of data are included in a patient portal and PHR?

PRHs can contain:Doctors' names and contact information.Allergy lists.Drug or medication lists.A record of illnesses or surgeries.A vaccination record.Chronic health conditions.Living wills or advance directives.Family histories.

What is DPC in healthcare?

Direct Primary Care (DPC), the affordable, simpler child of concierge medicine, is demonstrating we can stop waiting for payment reform for an effective payment model for primary care. That's no pipe dream as in the recent years over 1000 physicians have started DPC practices. Not only is DPC growing but, as this year's pandemic put many fee for service practices on financial life support, DPC's payment model proved very sustainable in tough economic times.

How long can you bill for 99215?

Remember, just as one example, that the longest time period one can bill for is 40 minutes as a 99215 for an established patient. The Medicare reimbursement for that code does not cover the cost of our staff.

What is the importance of trusting primary care physicians?

There is no doubt that a trusting relationship between primary care physicians and their patients is of utmost value in providing humane, and cost effective care , whatever the medical problem may be, as the authors have shown. It is something that all good primary care physicians strive for even though they are not always successful. It was my goal for the 45 years I was in practice.

Why are patients subjected to unnecessary and expensive tests and procedures?

And without that trust, patients are often subjected to unnecessary and expensive tests and procedures because of fears of malpractice litigation and accusations brought by the family , alleging that the doctor wasn’t thorough. Clearly, patient-centered care at times is incompatible with fee-for-service.

What is the problem with fee for service?

The problem with fee-for-service is more our inability to define "service" than it is to the payment method itself. Many of the "services" in a fee-for-service billing code are time-related and therefore equivalent to wages. Conceptually, output-based remuneration is the only system capable of providing incentives to ethical physicians to provide the right amount of care most efficiently. The two pre-conditions for such efficiency are 1) a comprehensive definition of "service" and 2) neither too many, nor too few patients being followed. Unfortunately, we really don't have anything close to appropriate service definitions. [Ref: Woodward R, Warren-Boulton F. Considering the Effects of Financial Incentives and Professional Ethics on ‘Appropriate’ Medical Care. Journal of Health Economics. 1984:3 (3):223-237.]

What are conflicts of interest?

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Is JAMA Network Open accepting submissions?

New! JAMA Network Open is now accepting submissions. Learn more.

What is common with the above alternative methods of payment?

What is common with the above alternative methods of payment is that they require more complex mechanisms than regulating FFS to ensure they function appropriately. This is to some effect inevitable as they were designed for the highly sophisticated U.S. healthcare system. Capitation payment in primary care may appear attractive, but aside from the caveats described, many countries have difficulty in attracting physicians to general practice. DRGs and P4P require well-designed patient identification, classification, recording and monitoring systems. In DRGs, measures to mitigate providers from up-coding (coding patients to higher paid groups than is appropriate) must be made. Monitoring under-provision of services is more difficult than overprovision in FFS because, for some patients, bed rest and observation may be the best treatment.

What is P4P payment?

Pay-for-Performance (P4P) gives bonus payment for physicians who achieve pre-defined clinical targets . Although in theory P4P is an ideal payment mechanism, there is at most mixed evidence of their results, and much depends on the context (7,8). Critics also voiced concerns about strict metrics used to evaluate performance. Keeping cholesterol and blood pressure below prescribed targets may be beneficial for population health, but not for all patients. Some “process-driven” P4P indicators, for example prescribing beta-blockers, are contra-indicated for some patients (9). Theoretically, P4P indicators could be developed based on risk adjusted outcomes, but physicians are generally uncomfortable and unconvinced with the results of such complicated statistical analysis. Methodologically, all P4P indicators must avoid the “ceiling effect” (providing additional income to nearly all) and the “floor effect” (payment so little as would be disregarded by most).

How to monitor adherence to conditions of billing?

Next, to monitor adherence to the conditions of billing, there must be a process of auditing the claims (bills) sent by providers. This would be of three levels. The first is screening by the administrative staff, which would be facilitated by electronic billing. The second is in depth reviews by physicians, preferably by prestigious clinicians of the same specialty. The third is on site audits of the medical records to cross-check whether the patient had actually met the conditions of billing for the services, drugs and so forth, with penalties for failing to provide documentation. Auditing would be easier for FFS than for other forms of payment because the government has data on the itemized services billed.

Why is designing and revising a fee schedule a daunting task for low- and middle-income countries?

Designing and revising a fee schedule is a daunting task for low- and middle-income countries because the disparity between the norms set in medical textbooks and the resources available is greater than in high-income countries. However, FFS should first be regulated before introducing more sophisticated methods of payment. This editorial has presented a conceptual explanation of how payment has been regulated by the fee schedule in Japan. For further details refer to the publication listed (11).

Why do physicians pay for FFS?

However, physicians have historically been paid FFS and it continues to be the dominant method in most countries. Physicians have preferred FFS because they would be compensated for delivering the best care to patients according to their professional standards. Physicians have also claimed that they waive or decrease payment for patients unable to pay by providing charity care with the balance met by charging rich patients.

Why is it important to know if a drug is protected by a patent?

For drugs, whether the drug is protected by patent or not is crucial because the industry has maintained that the high costs of launching a new brand drug come from Research and Development (R & D), not from its manufacturing. For devices and use of equipment, whether the patent is active or not is less important because, unlike drugs, improvements are constantly made, so that the price of an old model could be rapidly driven down by competition. Strict conditions of billing similar to that for services must be set in addition to meeting efficacy and safety standards evaluated by clinical trials.

What would happen if the imbalance was not addressed?

If the imbalance is not addressed, physicians in some specialties would continue to earn more income than others, and exacerbate the existing mal-distribution by attracting a disproportional share of medical school graduates. The market will not redress this imbalance because physicians can induce demand.

Getting Patients to Opt-In

It’s a disadvantage of both the provider and patient when clients decide not to use a patient portal. Patients are missing out on the potential benefits available to them. Providers also need to spend more time going over information with the patient that they could just access on the portal.

Security Concerns

The AMA also says that security concerns are the reason why 22% of people aren’t taking advantage of these services. These concerns were more common in patients over 40 years old.

User Confusion and Anxiety

There’s always the risk of confusion when using a new online platform. Trying to learn all the functionalities can take some time. This is why some accounts offer new user tours to guide the person through all of the features.

Alienation and Health Disparities

Other disadvantages of patient portals include alienation and health disparities. Alienation between patient and provider occurs for those who don’t access these tools. Sometimes, this is due to health disparities if a person doesn’t have a method for using them.

Extra Work for the Provider

With each of the disadvantages of patient portals that I already mentioned comes unintended extra work for the provider. Doctors want their clients to use this service they offer but opt-in rates are still low among patients.

Conclusion

Patient portals are set up to be a benefit for clients. When people opt-in to using these services, they can use quick on-demand features to make their health experience better. For instance, it’s easier to obtain medical records, immunizations, prescription information, and other details.

What is portal charge?

"The portal charge represents an incremental and recurring revenue stream for the practice in an era of challenging financial pressures like rising operating expenses and decreasing reimbursement ," said Stephen Armstrong, senior vice president for Hello Health, in an e-mail to Healthcare Dive.

Why is patient portal adoption growing?

Patient portal adoption among healthcare organizations is growing, in part because of the Stage 2 meaningful use requirements for patient engagement and in part because an increasing number of Americans like the idea of being able to connect with their healthcare providers digitally.

What is FFS in healthcare?

FFS is a volume-based system that can become costly and cumbersome for both the provider and the patient. With capitation, providers contract with an Independent Physician Association (IPA) to receive a flat monthly payment for every patient enrolled.

What is the purpose of CAPITATION?

Capitation, a quality-based payment model, is intended to create a system that fosters efficiency and cost-control while providing incentives for better health care .

Is FFS a good supplement to capitation?

In summary, FFS has been considered to be costly and ineffective by many medical providers but may serve as a valuable supplement for a capitation model in areas where capitation alone is infeasible. MACRA legislation has improved Medicare and driven the transition to capitation, which is seen as a more stable and financially sound method of payment arrangement, enabling providers to focus on the quality of care, rather than the number of services provided.

Is capitation feasible in California?

There is also debate whether capitation is financially feasible in all situations or not. In areas with high populations, such as California, some providers receive relatively low capitation rates from IPAs, which forces them to contract with FFS methods in addition to capitation.

Is capitation a good alternative to FFS?

Capitation may be an effective alternative to FFS in certain situations. Many providers believe that the optimal financial payment model is capitation, supplemented by FFS capabilities, to create, maintain, and grow a practice, it is essential to have a valid payment system.

Is capitation a good idea?

Capitation holds many benefits for providers, but it has its own set of considerations. Capitation can create a situation where providers opt to save money by implementing less expensive procedures and drugs instead of the more reliable, name-brand ones for the same service, and this would create a disparity between providers and pharmaceutical companies. There is also debate whether capitation is financially feasible in all situations or not. In areas with high populations, such as California, some providers receive relatively low capitation rates from IPAs, which forces them to contract with FFS methods in addition to capitation.

What is the problem with FFS patients?

The biggest problem with Fee For Service (FFS) patients for most dental practices is that the practice-patient relationship is merely transactional. With no allegiance to the practice, FFS patients will bounce from dental office to dental office trying to find the best “deal” on whatever treatment they think they need.

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