Skip to main content

Feature-ValueBasedPayment-1.png

Historically, the U.S. health care system has had different payment methodologies, depending on the care setting. Hospitals, skilled nursing facilities, and home health agencies typically have been paid under a prospective payment system model, while outpatient care typically has been reimbursed on a fee-for-service or discounted fee-for-service basis.

FFS, which has been used for decades, directs health care insurers to pay health care professionals for each intervention provided to the patient. (Discounted FFS, typically within managed care arrangements, calls for discounts on regular FFS fees when patients use in-network providers.) Critics of FFS — as described in the June 5, 2014, Forbes article "More Health Care Is Better Health Care: Myth or Reality?" — long have argued that it incentivizes health care professionals to provide and bill for the highest number of health care services per patient during each visit, even if the need for such services is not indicated.

Log in or create a free account to keep reading.


Join APTA to get unlimited access to content.


You Might Also Like...

Article

APTA Presses for Inclusion of CPT Codes in UHC Prior Authorization Reforms

Following UnitedHealthcare's Sept. 1 announcement eliminating 30% of prior authorization requirements for many of its plans, APTA reviewed the policy and

Article

Remembering Clarence W. Hultgren: A Lifetime of Leadership

Clarence W. "Clancy" Hultgren, PT, CAE, passed away on Aug. 5, at the age of 96. An APTA member for 68 years, Hultgren dedicated much of his career to

Article

APTA Builds Congressional Support for Medicare Payment Reform and Patient Access

In a Sept. 14 Capitol Hill briefing held in the Rayburn House Office Building for congressional staff, APTA members and staff experts detailed how the