Dermatology World

Shifting sands

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Changing reimbursement landscape has dermatologists wondering about the future

By Richard Nelson, managing editor, September 2, 2013

Accountable care organizations. Value-based payments. Fixed payment models. Outcome-based reimbursement. These phrases and others are swirling around the national conversation relative to health care, but they all point back to one phrase that gives everyone involved pause: Unsustainable spending trajectory.

“Health care spending growth is facing pushback from multiple stakeholders, even as the rates of increase have moderated somewhat in the last year or two,” said Jack S. Resneck Jr., MD, advisor to the American Academy of Dermatology Association’s Council on Government Affairs, Health Policy, and Practice and associate professor and vice chair of dermatology at the University of California San Francisco School of Medicine. “At a time when the federal deficit is getting substantial attention, Medicare and Medicaid are projected to be the primary drivers of increased government spending in decades to come.” But the pressure isn’t just coming from the government, Dr. Resneck added. “On the private side, insurers are facing increasingly stiff pushback from employers who are unwilling to sustain continued year-over-year increases in premiums that dwarf the rate of inflation.” 

Indeed, rising premiums are a threat to American competitiveness in a global economy, according to Rep. Jim Matheson (D-Utah), former co-chair of the Blue Dog Coalition and a member of the House Committee on Energy and Commerce and its Subcommittee on Health. “The fact that we spend about 50 percent more per person on health care than the next highest-spending country in the world creates a competitive disadvantage for us with the rest of the world in terms of how we perform in the business sector,” he said. Add to that the fact that health care spending is the primary driver for increased spending both at the federal level and in the states, where Medicaid is the fastest-growing component of almost every budget, and you find a broad consensus that something has to be done to control spending, Rep. Matheson said.