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Value-based care (VBC) continues to become a mainstream reality for health care providers. While a patient may not notice a difference between a value-based or a fee-for-service (FFS) approach, there is a stark difference for physician practices. It represents a complete paradigm shift.
VBC is a necessary approach that allows physicians to care for the whole person and promote strong global outcomes by prioritizing a preventative focus and redressing barriers to care. Whereas FFS promotes episodic treatment of the main presenting problem, VBC aims to encourage proactive care for the whole patient, with the reimbursement to support it. It’s a welcome concept for most physicians, yet this paradigm shift in care management also requires some pivotal shifts in practice management.
Case in point: Coding.
Redefining coding’s role
Coding has played a crucial role in practice revenue streams for decades. In the FFS environment, where practices are paid for each service delivered, Current Procedural Terminology (CPT) codes essentially set the reimbursement bar. Each CPT code describes a discrete service and carries a distinct payment rate. The more often patients come in for services, the more CPT codes are billed, and the more the practice earns.