The shift toward value-based care may be inevitable, but without equitable rules, it risks creating new inefficiencies, Nikhil Shetty, MD, said.
Dr. Shetty, COO of Midwest Interventional Spine Specialists in Munster, Ind., spoke with Becker’s about what he wants to see in value-based care.
Note: This conversation was lightly edited.
Q: What’s the biggest headwind you’re facing?
Dr. Nikhil Shetty: One of the biggest is insurance and the payer landscape. That’s something we’re all battling as private practitioners. But our government is moving toward a value-based care system. I see the pros of linking reimbursements to outcomes and improvements, and I do think that it does make sense across the board as long as it’s equitable.
And site-neutral payments I think are the lower hanging fruit. That’s an easier problem to solve once we neutralize the payments for procedures done agnostic of their site. I think we can see big cost savings right then and there. From there we can then move toward a value-based system where we take care of a patient with a bundle payment across a series of related events to a related healthcare issue where we eliminate unnecessary services, coordinate care and reduce complications. ASCs are leading the approach when it comes to cost savings, efficiency and proficiency in terms of the procedures that they’re able to do. We’ve led the way in that realm, and now we’re moving toward other steps in that process.
Q: Can you expand more on what you mean by making value-based care equitable?
NS: Traditionally value-based care is linking reimbursement to outcomes and overall value, not just fee for service or the volume of services delivered. Value-based care focuses on improving outcomes relative to cost. That creates different incentives from the provider side. Once we’re able to align our incentives with the betterment of the patient and direct the incentives in that way, I think we can move toward a place where we’re all comfortable receiving a bundled payment.
That’s what I mean when I say an equitable way of doing value-based care where there’s not some arbitrator deeming what is an episode, how long an episode is or how many “complications” are allowed to be in one episode. What I’m afraid of is you may link payments to one episode, and if incentives aren’t aligned, you may magically see down the line one patient having several different episodes just to get that care. Once we’re able to kind of clear that up, I think we can move in that direction.
