Department of Anesthesiology, University of Texas Medical Branch Galveston, Galveston, Texas, USA.
Acad Med. 2010 May;85(5):756-8. doi: 10.1097/ACM.0b013e3181d0fdfb.
Discussion of the flaws of the current fee-for-service health care reimbursement model has become commonplace. Health care costs cannot be reduced without moving away from a system that rewards providers for providing more services regardless of need, effectiveness, or quality. What alternatives are likely under health care reform, and how will they impact the challenged finances of academic medical centers? Bundled payment methodologies, in which all providers rendering services to a patient during an episode of care split a global fee, are gaining popularity. Also under discussion are concepts like the advanced medical home, which would establish primary care practices as a regular source of care for patients, and the accountable care organization, under which providers supply all the health care services needed by a patient population for a defined time period in exchange for a share of the savings resulting from enhanced coordination of care and better patient outcomes or a per-member-per-month payment. The move away from fee-for-service reimbursement will create financial challenges for academic medicine because of the threat to clinical revenue. Yet academic health centers, because they are in many cases integrated health care organizations, may be aptly positioned to benefit from models that emphasize coordinated care. The author also has included a series of recommendations for how academic medicine can prepare for the implementation of new payment models to help ease the transition away from fee-for-service reimbursement.
目前按服务项目收费的医疗保健报销模式的缺陷已成为人们讨论的焦点。如果不摒弃这种奖励医生提供更多服务的体系，而不论其是否必要、有效或有质量，医疗费用就无法降低。在医疗改革中可能会有哪些替代方案，它们将如何影响学术医疗中心面临的财务挑战？捆绑式支付方法越来越受欢迎，这种方法是在患者接受治疗期间为其提供服务的所有提供者共同分享一笔总额费用。此外，还有一些概念正在讨论中，例如高级医疗之家，它将建立初级保健实践作为患者的常规护理来源，以及责任医疗组织，根据该组织，提供者在特定时间段内为患者群体提供所有必要的医疗服务，以换取因加强护理协调和改善患者结果而节省的费用份额，或按每位成员每月支付费用。由于对临床收入的威胁，向按服务项目收费的报销模式转变将给学术医学带来财务挑战。然而，由于学术医疗中心在很多情况下是综合性的医疗保健组织，因此它们可能非常适合从强调协调护理的模式中受益。作者还提出了一系列建议，说明学术医学如何为实施新的支付模式做好准备，以帮助顺利过渡到按服务项目收费的报销模式。
