Commentary on the reimbursement paradox.
Reimbursement policies are a critical step in the incorporation of new technologies and therapies into the clinical armamentarium. Reimbursement is an umbrella concept describing the process to manage and pay for healthcare services, including benefit coverage, coding, and payment processes. The technologies and services used in therapeutic temperature management are not directly reimbursed, leading to challenges by hospitals and physicians that the services are too expensive to use. The reimbursement models used in the United States make it increasingly difficult for new technologies and therapies to gain direct reimbursement, part of a strategy by insurers, including Medicare and private insurance companies, to manage access to health care services. Insurers, physicians, hospitals, and other providers face conflicting financial incentives in current reimbursement systems. Aligning the financial incentives underlying reimbursement systems is necessary to adequately support new technologies of merit.
Reaven
Nancy L
NL
Strategic Health Resources, La Cañada, CA, USA. nancy.reaven@strathealth.com
Rosenbloom
Judy
J
D003422:Critical Care / Q000191:economics*; D039702:Current Procedural Terminology; D003953:Diagnosis-Related Groups / Q000191:economics; D004059:Diffusion of Innovation; D018166:Health Care Reform / Q000458:organization & administration; D006301:Health Services Needs and Demand; D006801:Humans; D007036:Hypothermia, Induced / Q000191:economics*; D007348:Insurance, Health / Q000191:economics; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D018803:Models, Economic; D010818:Practice Patterns, Physicians' / Q000191:economics; D012051:Reimbursement Mechanisms / Q000458:organization & administration*; D015895:Relative Value Scales; D014481:United States