Two Wrongs Do Not Make a Right: Flaws in Alternatives to Fee-for-Service Payment Plans Do Not Mean Fee-for-Service Is a Good Solution to Rising Prices Comment on "Fee-for-Service Payment - An Evil Practice That Must Be Stamped Out?"

Abstract

Professor Naoki Ikegami's "Fee-for-service payment -an evil practice that must be stamped out" summarizes many of the failings of alternatives to fee-for-service (FFS) payment systems. His article also offers several suggestions for improving FFS systems. However, even powerful arguments against many of the alternatives to FFS, does not make a convincing argument for FFS systems. In addition, there are significant misunderstandings in Professor Ikegami's presentation of and use of United States payment methods, the role of private vs. public insurance systems, and the increasing role of "accountable care organizations. " Keywords: Cost, Fee-for-Service (FFS), Accountable Care Organizations Copyright: © 2015 by Kerman University of Medical Sciences Citation: Koppel R. Two wrongs do not make a right: flaws in alternatives to fee-for-service payment plans do not mean fee-for-service is a good solution to rising prices: Comment on "Fee-for-service payment -an evil practice that must be stamped out?".

A Comparison of Home Health Utilization, Outcomes, and Cost Between Medicare Advantage and Traditional Medicare

“…However, there are structural differences between MA and TM that could have led to these results. 20 MA plans offer programs and benefits that are not available to TM participants and may serve to enhance outcomes and improve the efficiency of home health care delivery by addressing a broader range of needs. Chief among them is holistic care coordination by nurse care managers who help patients with complex needs or provide support following hospital discharge.…”

“…Our study was not designed to delineate the exact mechanisms by which MA enrollment would lead to improved patient-centered outcomes and reduced utilization for users of home health. However, there are structural differences between MA and TM that could have led to these results 20. MA plans offer programs and benefits that are not available to TM participants and may serve to enhance outcomes and improve the efficiency of home health care delivery by addressing a broader range of needs.…”

“…Experts have expressed concerns that the financial incentives inherent to TM may lead to home health overuse and do not promote maximizing quality and value. 20 Despite the growing role MA plays in financing home health, little is known about how outcomes and costs following home health compare between beneficiaries enrolled in MA and those enrolled in TM. The aims of this study were to: (1) describe the intensity of home health services for MA and TM and (2) examine the association between MA enrollment and patient-centered outcomes, utilization, and medical costs among patients who used home health.…”

“…Therefore, they have an incentive to manage care networks and facilitate optimal care transitions, as well as an ability to offer care management services and supplemental benefits, such as transportation or meal delivery, that are not available to participants in TM. Experts have expressed concerns that the financial incentives inherent to TM may lead to home health overuse and do not promote maximizing quality and value 20…”