VBC will never be a solution since it looks at healthcare from the revenue down and healthcare was never meant to be a profit center nor should it.
Almost all of the complexities you outline are created by those that profit from rather than provide care. These complexities simply become self fullfilling proficiens for the companies that created them.
A perfect example is the codes they have created for an initial office visit.
CPT Code Description Time Spent (Minutes) Medicare Reimbursement Rate
99202 New patient, straightforward medical decision-making 15–29 $71.06
99203 New patient, low complexity medical decision-making 30–44 $109.69
99204 New patient, moderate complexity medical decision-making 45–59 $164.38
99205 New patient, high complexity medical decision-making 60–74 $216.77
99211 Established patient, may not require the presence of a physician 5–10 $22.92
99212 Established patient, straightforward medical decision-making 10–19 $55.67
99213 Established patient, low complexity medical decision-making 20–29 $89.39
99214 Established patient, moderate complexity medical decision-making 30–39 $126.07
99215 Established patient, high complexity medical decision-making 40–54 $177.47
There is nothing value based about any of these codes nor is there any value to the actually care of the patient. What there is, is a lot of ambeguity that a;;own for an insurance company to deny care while hiding behind UM.
So much of what the insurance companies demand is "evidence based" so why ar they not held to the same standard?
The undisputed evidence of insurance is that the top six insurance companies make $100,000,000.00 PROFIT PER DAY. This would refute any evidence of over utilization.
The system we have is broken thinking that those that profit from it are going to change it is also broken. The majority of the abuse by physicians is driven by the complexity of the very system created by those that are wanting to manage it.
VBC will never be a solution since it looks at healthcare from the revenue down and healthcare was never meant to be a profit center nor should it.
Almost all of the complexities you outline are created by those that profit from rather than provide care. These complexities simply become self fullfilling proficiens for the companies that created them.
A perfect example is the codes they have created for an initial office visit.
CPT Code Description Time Spent (Minutes) Medicare Reimbursement Rate
99202 New patient, straightforward medical decision-making 15–29 $71.06
99203 New patient, low complexity medical decision-making 30–44 $109.69
99204 New patient, moderate complexity medical decision-making 45–59 $164.38
99205 New patient, high complexity medical decision-making 60–74 $216.77
99211 Established patient, may not require the presence of a physician 5–10 $22.92
99212 Established patient, straightforward medical decision-making 10–19 $55.67
99213 Established patient, low complexity medical decision-making 20–29 $89.39
99214 Established patient, moderate complexity medical decision-making 30–39 $126.07
99215 Established patient, high complexity medical decision-making 40–54 $177.47
There is nothing value based about any of these codes nor is there any value to the actually care of the patient. What there is, is a lot of ambeguity that a;;own for an insurance company to deny care while hiding behind UM.
So much of what the insurance companies demand is "evidence based" so why ar they not held to the same standard?
The undisputed evidence of insurance is that the top six insurance companies make $100,000,000.00 PROFIT PER DAY. This would refute any evidence of over utilization.
The system we have is broken thinking that those that profit from it are going to change it is also broken. The majority of the abuse by physicians is driven by the complexity of the very system created by those that are wanting to manage it.