Rising to the Challenges of the Evolving Reimbursement Environment

July 2, 2013Articles Western Pennsylvania Healthcare News

Health care in the United States is undergoing another episode of dramatic change, but its significance has been amplified by highly polarized politics, online media sources and the 24/7 news cycle. Forward-thinking hospitals and provider networks can position themselves to seize opportunities and minimize heightened risks presented by this turbulent time, but only if they develop effective data gathering and analysis tools.

Despite the firestorm that continues to rage over the Affordable Care Act (“Obamacare” to its opponents), the reimbursement changes it includes are relatively incremental and, in many cases, optional. Contrast them with the radical realignment that was suddenly ushered in by the advent of DRG’s in 1983 under the Medicare prospective payment system, which required hospitals to rapidly adapt to fixed fees per admission after decades of cost-based Medicare reimbursement.

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