Hospitals Say So Long to Fee-for-Service

Mar 16, 2015

Josh Luke, founder of the National Readmission Prevention Collaborative, moderates a panel at the University of South Florida on case management.
Credit Daylina Miller/WUSF News

The need to reduce patient readmission rates is leading hospitals across Florida to share ideas with one another.  

The “fee-for-service” payment era is over, and concepts like accountable care organizations (ACOs) are becoming the norm, said health care professionals gathered at the Florida Readmissions Summit at the University of South Florida in Tampa last week.

Instead, hospitals and doctors are getting used to being paid - or penalized - by how well patients fare during and after treatment. Last fall, 148 of 167 Florida hospitals were fined for having too many Medicare patients return within a month for additional treatments, Kaiser Health News reported.

ACOs help, by coordinating care for Medicare patients and if money is saved, splitting the savings with the federal government, said Chris Nesheim, vice president of care management for Lee Memorial Health System in Fort Myers.

"We're moving towards preparing for the ACO world,” Nesheim said. “We do have one foot in the old world and one foot in the new and our goal is ultimately to keep the patient out of the hospital and make sure they have the resources they need to be safe at home."

Josh Luke, founder of the National Readmission Prevention Collaborative, said hospital CEOS and doctors were raised in an era where they were rewarded financially for keeping people in the hospital.

That is prompting providers to think outside-the-box in terms of making sure patients have resources available to help them heal and keep them well, he said.

Hospitals are even working to keep people out of the traditional in-patient hospital business in the first place, a thought that would have been incomprehensible in the fee-for-service era, Luke said.

“We’re really focusing on educating everyone that that hospital of the future is at home… so how can we get to a model where doctors and providers aren’t (given) incentives to keep people in the hospitals and nursing home? How can we get to a model where they (get) incentives to care for people at home? “ Luke said.

Additional readmissions summits will be held in Colorado, California and New York later this year. 

Daylina Miller is a reporter for WUSF in Tampa. Health News Florida receives support from the Corporation for Public Broadcasting.