For decades, it was easy to determine the quality of care a patient received: The quality of service directly correlated with the patient’s out-of-pocket fee. The fee-for-service healthcare payment model standardized care regarding how much, or what to what degree of quality the patient received.
Utilization management is undergoing a significant shift in today’s healthcare industry. Seen as a system for reviewing the medical necessity, appropriateness, and reasonableness of services proposed or provided services to patient groups, the utilization review/management process focuses on two primary objectives: to improve the quality of services and patient outcomes and to ensure that resources are used appropriately.
Hospital administrators have MACRA on the mind, especially those who are in the active process of transitioning from fee-for-service to value-based care for their Medicare and CHIP patients. The 2015 bi-partisan ruling set in place a series of events that eventually led to the branching off of the MIPS (Merit-based Incentive Payment System) and APM (Alternative Payment Model).
Mediating at the crossroads between health care, public health, and universal safety, EMS provides out-of-hospital acute care to patients with illnesses and injuries that constitute a medical emergency. More than a transportation medium to definitive care, EMS plays an intricate role in today’s healthcare system; controlling multiple components that impact the coordination and seamlessness of patient care in a high-stress, fast-paced medical climate.