New Healthcare Insurance Guidelines for Hospital Payments Begin

In the recent Wall Street Journal May 16^th issue, Wellpoint, one of our nation's leading healthcare insurance carriers stated that they were cutting the cord on reimbursments and annual increases for 1,500 hospitals across the fruited plain.

The company has decided to reinstate a new system to replace the current one, in an effort to compensate itself for the rising healthcare and medical costs presently at 14 different hospitals in different states. These hospitals insure their staff with Blue Cross Blue Shield plans that manage over 34 million people nationwide. An 8% increase has been the average it's paid to these healthcare facilities over recent years.

A higher standard of quality is now going to be the criteria under the new system once it becomes implemented. Increased quality will be measured by a new test that requires 51 specific aspects of treatment quality that must be met including such things as prevention of relapses from health conditions post-hospital admission, strict adherence to safety checklists, and patient satisfaction after treatment. Those hospitals that fail to reach these goals with poor scores will not obtain their payment increase.

This comes via the new changes that are becoming part of the expansive health industry shift towards reimbursing our healthcare providers contingent upon the quality of healthcare provided by each hospital individually. This is thought to be a better way to go rather than basing their payments on test and treatment volume. The article goes on to state that next year, the Obama administration will look into new ways to pay hospitals via the Medicare system so only those facilities with higher quality patient care outcomes will receive higher reimbursement payments.

Lobbyists state that Wellpoint is first in being a major insurer to make a system like this mandatory for those hospital facilities who directly serve their health plan affiliates. The formula that Wellpoint has devised to measure care quality is based on 55 % health outcomes, 35% good patient safety records, and the remaining 10% is focused on patient satisfaction.

Speculation that those facilities in urban and poverty stricken neighborhoods may suffer some penalties creates concern for some. Such hospitals frequently care for those patients that are often times very ill and are more expensive to care for. Chip Kahn, president of the Federation of American Hospitals, a trade group representing made the statement that those types of healthcare facilities don't have good outcome measurements, and that "many things will happen 30 days after discharge that have nothing to do with hospital care."

Source: Wall Street Journal Monday May 16th issue