As both an essential service and a sprawling business, best practice standards for healthcare are constantly subject to change as the industry evolves. At the forefront today stand two emergent and essentially antipodal approaches: volume-based care and value-based care. The former prioritizes maximizing total reimbursement by (e.g.) rendering the most significant possible number of services and seeing patients in bulk; the latter adopts a more “humanistic” outlook, critically emphasizing effectiveness of care, ideal health outcomes, and patient contentment. While sincerely ethics-focused, the methodology here isn’t merely altruistic: at root is the (evidence-supported) supposition that consistently high patient satisfaction yields dividends via curtailed expenses and faster, more reliable reimbursement.
More succinctly, with value-based care, everybody wins.
Read below for more on the system’s merits and reasons not to opt for volume-based care, its inferior inverse.
A Looming Administrative Quagmire
Thanks to federal initiatives like HITECH and Meaningful Use, which emphasize/engender meticulous documentation and billing strategies, the healthcare domain seems “naturally” inclined to gravitate toward volume-based care. This shift has inadvertently birthed an environment burdened with administrative duties, leading to overwhelming clinical burnout and plummeting patient satisfaction. Strategies incorporating dictation, transcription, medical scribes, and the like have attempted to ease this burden, but with little success or utility beyond the short term.
Drawbacks of Volume-Based Care
Volume-based care, also slangily (and somewhat pejoratively) termed “fee-for-service,” inherently brings about an array of adverse conditions that detrimentally affect patient outcomes and provider well-being. Why/how?
1. Quantity Over Quality: In this model, healthcare providers and establishments receive compensation based on the number of services dispensed or procedures conducted. Such an approach can inadvertently lead to excessive diagnosis and screening, stretching resources thin and adversely affecting patients.
2. Excessive Administration: The emphasis on quantity over quality burdens healthcare providers with a staggering administrative workload. Clinicians find themselves compelled to code excessively and document every minutia to guarantee optimal reimbursement. This infringes on the clinical day, leaving providers grappling with documentation during visits and needing help fully engaging with their patients. The outcome? Reduced patient satisfaction, heightened documentation demands, and less patient review and preparation time.
3. Burnout and Patient Satisfaction: The pressure to see as many patients as possible while fulfilling administrative requisites often pushes providers to their limits. This strenuous scenario frequently leads to burnout and diminishing patient satisfaction. Medscape’s 2022 Physician Burnout and Depression report highlights that 47% of physicians are experiencing burnout, with administrative tasks like documentation being a significant contributor.
Unnecessary Procedures
Under volume-based systems, providers might resort to unnecessary procedures or excessive billing to maximize revenue. This can inflate healthcare costs, erode trust in the healthcare system, and compromise patient care, provider contentment, and overall healthcare expenses.
Embracing Value-Based Care
In contrast, value-based care provides an all-around refreshing perspective. Unlike its volume-focused counterpart, value-based care accentuates care quality. The aim is to heighten patient outcomes by encouraging preventive measures and supplying efficient, cost-effective care. It revolves wholly around patient satisfaction, positive/healthful medical results, reduced hospital readmissions, and other such markers of success.
An Integrated Approach
Value-based care takes a holistic approach, addressing not just the medical concerns of patients but also their social determinants of health. By prioritizing preventive care and tackling chronic conditions, this approach endeavors to minimize doctor visits, rewarding organizations for their success. This shift can reduce provider burnout, promoting job satisfaction and genuine patient connections.
Closing Thoughts
Despite the potential benefits of value-based care, its implementation must be improved. A paradigm shift from volume-based models demands a systematic overhaul with buy-in from stakeholders and decision-makers. The transition cannot happen overnight, entrenched as it currently is (to whatever extent) within the existing infrastructure centered on EHRs, documentation, reimbursement, etc. The industry remains years away from fully embracing value-based care, but it is the direction things are headed—and wisely so. Of all the things you have to worry about in your medical practice, the way you store, access, and manage patients’ health information is a big one. EHR (Electronic Health Record) systems are a widely popular solution to the issues surrounding maintaining this information. There are several types of EHR systems, and most medical practices use one. The high initial cost can be why you might resist changing or upgrading your EHR system; however, you should not ignore these signs that the time is right to leap.
The Workflow Is Inflexible
When you first switched from paper-based systems to your EHR system, you probably had some stumbles as you adjusted to the workflow. With paper, the workflow is always flexible, but with an EHR system, it can feel rigid. Hopefully, this eased as you got comfortable with the system, but if it did not, that is a sign that you might need to upgrade to a better EHR system so you can focus on patient care again.
It Doesn’t Grow
Ideally, your practice is growing as you get more and more established. You need an EHR system ready and able to grow with you. If it cannot, it will hold you back from meeting the full potential of your practice and meeting the needs of your patients or clients.
Your Vendor Doesn’t Provide Good Service
If the customer service from your vendor doesn’t meet your standards, you will be better off with a different vendor (and a different product). Similarly, if you always have technical issues, the problem might be with the EHR system rather than you and your staff.
It Isn’t Stage 2 Meaningful Use Compliant
Entering the second stage of meaningful use requires updates to EHR system software to stay in compliance. If your vendor and current software aren’t stage 2 meaningful use compliant, they will hold you back.
There Are Hidden Expenses
If you’re receiving bills for things you didn’t know were added costs, and you never seem to be able to stay within your budget, this is a sign that your vendor needs to be more transparent, and you should make a change.
They Aren’t Improving It
If there are no improvements to the system in the works, it will stagnate and not meet your needs in the long run. The system should be upfront about what progress and improvements they are planning and when you can expect to see them so you know how to employ them for the success of your practice.
There Is Not Mobile Access
Tablets and smartphones are here to stay and are as much a part of the medical professional’s toolkit as a computer. If your EHR system only works on a computer, it will stop meeting your needs sooner.
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