ABSTRACT
This chapter highlights several significant factors responsible for the rapid rise in health-related expenditures. Accountable care organizations are structured to be the equivalent of “one-stop shopping,” where all of the patient’s needs are obtained through a single healthcare system for diagnostics, treatment, and rehabilitation. Reimbursement for healthcare has been under downward pressure for several years. Newspapers have published articles citing the “greed” of hospitals, physicians, and healthcare providers. The Hospital Value-Based Program (VBP) is outlined in Section 1886(o) of the Social Security Act. The Hospital VBP Baseline Measures Report allows providers to monitor their performance in all domains and measures required for the Hospital VBP Program. Hospitals are getting bonuses under pay-for-performance systems and for reducing infections, but this does not change the underlying payment system and its rewards for providing more services. One safety net for expensive services such as hospitalization is a catastrophic plan, which is essential because its premium may be lower than that of traditional insurance.
