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Competition in Healthcare and Non–Fee-for-Service Revenue Arrangements

Competition in Healthcare and Non–Fee-for-Service Revenue Arrangements

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Ronald B. Sterling, CPA, MBA
The Medicare Quality Payment Program and other non–fee-for-service (non-FFS) programs from a variety of payers pose new patient service and care challenges to practices and healthcare organizations (HCOs). Revenue generation is moving from completion of a patient encounter or procedure to sustained patient service excellence over a month, months, or even a year. Compensation for non-FFS arrangements may be based on a standard of performance or require your practice to develop innovative ways to serve patients and manage their health. Shared savings, care management, episode of care, and other non-FFS arrangements require new patient service strategies and tactics. Further complications are the specific scope of services and target patient populations from each payer and program. The success of your practice/HCO will depend on how well you meet non-FFS requirements and also how well you compete with the convenience and cost of a clinic associated with your local pharmacy. Your plan to address these challenges relies on using technology, redesigning patient service methods, and continually monitoring results.