“The reimbursement battle rages on, a healthcare tug-of-war with patients caught in the middle.”
By Dutch Rojas
On one side, we have the payers – the insurers, the government, the ones holding the purse strings.
They look at the rising healthcare costs and say, “Enough is enough.”
They implement a hierarchy of reimbursement, paying top dollar for hospital care, a bit less for outpatient facilities, and even less for those lowly office-based procedures.
The logic seems sound at first glance.
Hospitals have the highest overhead, so they should get the highest reimbursement.
Those 24/7 staffing needs and high-tech equipment don’t come cheap.
But then we have the facility providers – the hospitals and health systems that own and operate the care locations.
They look at this reimbursement structure and see a golden opportunity.
Why perform a routine procedure in a doctor’s office when you can shuffle the patient to your hospital outpatient department and rake in 2-3 times the reimbursement?
It’s a tempting incentive, a siren song luring facility providers towards higher acuity settings, even when not medically necessary.
The physicians themselves may not be swayed, as their reimbursements remain separate.
But are the health systems pulling the strings behind the scenes?
They have every reason to succumb to the financial allure.
Critics cry foul, arguing that reimbursement should be based on the service, not the facility’s overhead costs.
Why should a patient’s colonoscopy cost triple the price simply due to the location when the procedure remains unchanged?
Facility providers retort that these higher reimbursements allow them to maintain crucial emergency capacity and advanced services for the greater good of the community.
They paint themselves as altruistic heroes, bearing the financial burden for the benefit of all.
And so the reimbursement battle rages on, a healthcare tug-of-war with patients caught in the middle.
Will we ever find the perfect balance, a system that fairly reimburses providers without perverse incentives pulling the strings?
It’s a conundrum as complex as the human body itself.
But one thing is sure – in the grand scheme of healthcare, reimbursement ought never eclipse the true goal: providing the right care at the right time, in the right setting, for the health and wellbeing of the patient above all else.
