Group Culture

The Devaluation of Value-Based Billing

November 7, 2016

“Value based billing” remains dominant in the medical industry news, chiefly from the MACRA angle. Mostly, though, it’s a lie because value is determined by the customer, not by some bean counter at CMS. Sure, CMS may be paying the bill for Medicare patients, but the patients are the actual customers and only they can assess whether value was truly delivered.

Yes, I know. I can hear you out there, the third guy from the left, wearing khakis and a white lab coat, muttering, “But, CMS is paying the bill.” And, of course, that’s the problem. Once organized medicine (read that as the letters A, M and A) bought into the concept of Medicare in 1965, physicians opened the doors to government meddling. After all, if the government is going to pay, the government is going to demand something, and something more and more and more, as the price for payment. To quote President Reagan, “The nine most terrifying words in the English language are, ‘I’m from the government and I’m here to help.’”

When you hear the words “value based” in connection with healthcare, just view them as a flare in the night warning you that within the next moment or so you’ll hear something that sounds socially useful but which has nothing, or very little, to do with anything other than figuring out how to pay you less or control you more. This is especially true if the comments are coming from an “economist,” because economics is the study of who gets what in the actual world, while today’s so-called “economists” are those who’re preaching who should get what in their imagined world. Unfortunately, these folks are often paired with those who have guns, i.e., the government, to enforce their nonsensical theories.

If you don’t believe that value is determined by the patient, here’s an interesting story, as noticed on the web from the site of Florida TV station WPTV.

An expectant mother, Paula D’Amore, was in labor and on her way to Boca Raton Regional Hospital with her husband. They were just a wee bit late, as the baby popped on out in the D’Amore’s car in the hospital parking lot with help from Mr. D’Amore followed by some assistance from a few nurses who came on out to their car.

The value issue?

Well, the hospital decided to bill Ms. D’Amore the full charge of the use of its delivery room, over $7,000, even though neither Ms. D’Amore or her baby were ever in the delivery room. (Attention hospital CEOs: neither car nor parking lot equals delivery room.)

Another local news outlet, the Sun-Sentinal newspaper, reports that the hospital’s vice president for marketing said the hospital felt that the delivery room charge was a suitable bill. Perhaps the paper got the guy’s title wrong, because it seems more like “VP of sales prevention” than of marketing.

The point, of course, is that the value of the services received by Ms. D’Amore can only be assessed from her point of view, not the hospital’s. Even more ridiculously, is to assume that someone over a thousand miles away, as in Washington, DC, can determine value.

Yes, the payor can dictate the amount that they will pay. But at least let’s be honest about this and acknowledge that that amount has nothing to do with value. Of course, saying “screw you, this is what we’re paying and this is the data you have to give us before we’ll give you even that” isn’t politically correct, and these folks are if anything, politically correct.

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