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How can smaller practices compete in value-based-reimbursement world?


Medical Economics recently spoke with Daniel K. Zismer, Ph.D., a co-founder and managing director of Castling Partners, a Minneapolis-based healthcare management advisory firm, about how organizations of different sizes can succeed in the value-based-reimbursement world. Among his remarks:

Medical EconomicsThe big question: How can a smaller practice compete with larger practices under value-based reimbursement?

“Mr. Zismer: To play to win in this environment, practices may have to do something many don’t want to do—be part of that larger, more integrated, sophisticated health system that can go upstream while contracting with both insurance and the government.

“The average health system has fewer than five payers that matter to the whole revenue stream in a major way. With such a consolidated payer marketplace, there really isn’t a payer interested in trying to aggregate and contract separately with hundreds of small medical practices.

“Payers are more attracted to larger, more integrated sophisticated systems of care delivery that have a more resilient economic model. Smaller practices should get organized and positioned to play in this era of experimentation, understanding that health insurance providers are interested in creating value-based programs. They may not, however, be interested in creating models and methods so that any provider of any size and scale can participate with them.”

To read the whole interview, please hit this link.


When they won’t get better

Daniel J. Lamas, M.D., looks  at what to do when when a chronically critically  ill patient  probably won’t ever get better.

Among his remarks:

“Chronic critical illness is not something I learned about in medical school, or something that many doctors even talk about. One reason might be that the care for the chronically critically ill quite literally takes these patients out of our view – they move, as my patient did, from hospital to long-term care and back again, accompanied by a growing stack of medical records as things slowly fall apart.

“In the early moments of critical illness, the choices seem relatively simple, the stakes high – you live or you die. But the chronically critically ill inhabit a kind of in-between purgatory state, all uncertainty and lingering. How do we explain this to families just as they breathe a sigh of relief that their loved one hasn’t died? Should we use the words “chronic critical illness”? Would it change any decisions if we were to do so? Here, I find that I am often at a loss.”

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