Fee-for-service model may no longer be effective, say speakers
South Carolina Hospital Association president and CEO Thornton Kirby would be the first to say the state of health care can look a bit alarming.
For instance, Americans spend more on health care than many of their developed nation peers, but live significantly shorter lives and are less healthy on their way to early deaths, he said at a Ten at the Top Healthcare Forum held last week at Crowne Plaza in Greenville.
“How is it that we’re spending more money on health care and not living as long and we don’t have the same quality of life that other nations do?” he said, speaking to a packed room of nearly 100 business leaders, health care professionals and local leaders. “This is a challenge that we have to engage. We can’t avoid it, we have to talk about it and figure out why.”
Many challenges and structural issues in our health care system today can be traced back to what the system was originally intended for, Kirby said. Efforts to reduce runaway inflation during World War II, for example, introduced limits on salaries, which prompted employers to attempt to draw workers with non-wage benefits such as health insurance. The result was an employer-sponsored health insurance precedent that differed from the more common, government-involved health insurance model in other developed countries, he said.
“It doesn’t necessarily work perfectly. It’s not necessarily how you as a group would probably have conceived of how policy was created for the nation, but that’s how we got it,” he said. “It has a lot less government controls on it than most systems … which means there’s probably more of a profit motive opportunity in ours than in ones that are strictly government-operated.”
But the current profit model for providers is a fee-for-service model, said panelist David Isenhower, the chief medical informatics officer for Self Regional Health System. Providers care about the ultimate quality of service to their patients, but they only get paid for services, which misses the opportunity to focus on other aspects of care, he said.
“The payment model has to shift from fee-for-service over to some portion of the value to the providers being fees for other things,” said Isenhower, who sat alongside Rosenfeld Einstein Principal Howard Einstein, Bon Secours St. Francis Health System Senior Vice President of Medical Affairs Saria Saccocio, and Greenville Health System Vice President of Clinical Integration and Chief Medical Officer Angelo Sinopoli.
“Most practitioners I talk to actually want to get back to the practice of care,” said Sinopoli. Alternative payment methods could be attractive options because they can boost overall better outcomes, Sinopoli said; rather than doing mounds of paperwork, providers could focus on the reason they chose health care as a profession.
“We have long paid for what we refer to as volume, the number of procedures done,” he said. “We really ought to begin paying for how well the health care system manages a patient’s health.”
Despite problems, Kirby said he remains optimistic about the potential for improvement with South Carolina’s – as well as the country’s – health care system.
“The trends in our state are very much focused on improving where we have structural flaws,” he said. “Your leaders in this state are not only focused on quality of care and driving it. They’re successful at it.”
