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| Business World Magazine |
November 2012
tests the growing cost of healthcare is un-
sustainable. With methodologies shifting to
what he describes as “value and risk-based
payment structures while providing quality
care,” Dr. Polner says changes will impact the
way healthcare is delivered and reimbursed,
and that “portends danger and opportunity.”
While there are many examples of the
changes occurring, one involves the manner
in which reimbursements are provided by
Medicare and Medicaid. In Florida, a large
percentage of the cost involving care for frail
elderly and disabled is provided through
Medicare andMedicaid. In the course of car-
ing for this demographic, there are occasions
when a patient, following the receipt of care
in a hospital, is then discharged and admit-
ted to a nursing home or assisted living facil-
ity. Due to the enactment of new protocols
in Florida and federal law, should a patient
become sick or afflicted after admission (ne-
cessitating readmission to a hospital within a
period of 30 days) care providers MAY not
receive the reimbursements they have typi-
cally been afforded. In other scenarios, there
are insurance companies that have dropped
physicians, without cause, from their ap-
proved provider list “for business and eco-
nomic reasons”. In the past, while in the
course of treating a patient, the physician
determined when (and to what extent) tests
and referrals to specialists were needed to
fully evaluate the patient’s condition. The
fact remains that there is not enough collab-
oration between primary care physicians and
specialists, which inevitably results in over-
utilization of services and lack of coordina-
tion of care that could otherwise improve
patient care while reducing costs.
These, and other changes, have forced
some physicians to forego private practice
for positions with hospitals perceiving this
offers greater job security. Once more, this