In value-based care, providers are paid based on how well they help patients stay healthy and improve their outcomes, rather than just how many services they provide.

This change is happening because people want healthcare to be more efficient and affordable, while also focusing on the health of the patients.

The government programs like Medicare (which helps people over 65 and those with long-term disabilities) and Medicaid, as well as private insurance companies, are all encouraging providers to use new payment models. These include systems like Accountable Care Organizations (ACOs), where providers work together to improve care and save money, or “bundled payments,” where a group of services is paid for at once.

Value-based care is important for healthcare providers, including doctors, hospitals, and clinics. They need to understand these new payment models to stay financially stable while also giving the best care to their patients.

In this blog, we will explore what value-based care is, how it works, and how it can help providers deliver better care while managing costs.

Understanding Value-Based Care Model in Healthcare

Value-based care is a way of providing healthcare that focuses on giving patients the best care for their health, while also keeping costs down.

Unlike the old system called fee-for-service, where doctors and hospitals get paid for each service they provide, value-based care rewards healthcare providers for achieving better health outcomes and improving patient experiences.

In value-based care, “value” means what matters most to patients – getting the right treatment, staying healthy, and having a good experience with their healthcare. This system focuses on high-quality care, better patient results, and teamwork between doctors and other healthcare providers. It aims to prevent health problems and manage ongoing conditions in a way that reduces the need for unnecessary tests or hospital visits.

Advantages of Value-Based Care

Better Health: It helps improve patients’ overall health by focusing on the right care. Lower Costs: By reducing unnecessary treatments, tests, and hospital visits, value-based care helps lower the costs of healthcare for everyone. Happier Patients: Because the system cares about patient needs and satisfaction, patients tend to be more happy with their care. Better Coordination: Doctors and other healthcare providers work together to make sure patients get the best care without any gaps or confusion.

Disadvantages of Value-Based Care

Expensive Changes: Moving from the old system to value-based care can be costly for hospitals and doctors, as they need to invest in new technology and training. Financial Risks: Doctors may face penalties if their patients don’t do well or if they don’t meet certain care goals. Out-of-Pocket Costs: Patients might have to pay more if they see doctors or hospitals that are not part of their insurance network. More Work for Providers: Doctors and hospitals need to track more data and report their results, which can add extra work and cost.

Value Based Care vs Fee-for-Service Care

Fee-for-service is about paying for each action or service, while value-based care is about paying for good outcomes and helping patients get better in the most efficient way.

Example of Fee-for-Service

Imagine you go to the doctor because you have a sore throat. The doctor charges you for each visit, test, or medicine you get. If you need to come back for more visits or tests, the doctor gets paid each time. The doctor is paid based on the number of things they do for you, not whether those things actually help you feel better.

Example of Value-Based Care

Now, in a value-based care system, the doctor is paid based on how well they help you get better, not just how many things they do for you. So, if the doctor helps you recover quickly, with fewer visits and tests, they get paid a fair amount. The goal is for doctors to give you the best care that helps you feel better without unnecessary treatments or costs.

What are Medicare Value-Based Programs?

Medicare Value-Based Programs are special programs from the Centers for Medicare & Medicaid Services (CMS) that help improve the quality of patient care. These programs focus on giving better care, improving patient health, and reducing costs. Instead of paying healthcare providers based on how many services they give (called “fee-for-service”), these programs pay based on the quality of care and the results for patients.

Some of these programs include:

• End-Stage Renal Disease Quality Incentive Program (ESRD QIP)
• Hospital Value-Based Purchasing Program (VBP)
• Hospital Readmission Reduction Program (HRRP)
• Value Modifier Program (VM), also called Physician Value-Based Modifier (PVBM)
• Hospital Acquired Conditions Reduction Program (HAC)
• Skilled Nursing Facility Value-Based Purchasing Program (SNFVBP)
• Home Health Value-Based Purchasing Program (HHVBP)

Let’s explore each program in detail:

1). End-Stage Renal Disease Quality Incentive Program (ESRD QIP)

The ESRD Quality Incentive Program (ESRD QIP) started on January 1, 2012. It is the first program that requires dialysis centers to earn money based on how well they care for patients with kidney failure (also called end-stage renal disease or ESRD).

This program encourages dialysis centers to improve their care by linking part of their payment to how well they perform on certain tasks.

Example: A dialysis center works on making sure they use better methods to avoid infections. If they reduce infections, they improve patient safety and get all of their Medicare payment.

How it works?

Performance Measures: Dialysis centers are scored based on how well they prevent infections, how happy patients are, and how well they report their data.

Payment Adjustments: If the center does not do well, they may lose up to 2% of their Medicare payments.

Transparency: The scores of each dialysis center are made public, and they must show their scores for everyone to see.

2). Hospital Value-Based Purchasing (VBP) Program

The Hospital Value-Based Purchasing (VBP) program started in the early 2010s. This program rewards hospitals for providing better care and improving the patient experience.

Hospitals can earn more money by improving their care quality and patient satisfaction.

Example: A hospital improves its treatment of serious infections like sepsis by using better methods. They also train staff to be more patient-friendly. As a result, patients are happier, and there are fewer deaths. The hospital earns back the money that was withheld and may get extra rewards.

How it works?

Scoring Metrics: Hospitals are judged based on how well they prevent deaths, how safe they are, how they use resources, and how happy patients are (measured by surveys like HCAHPS).

Payment Adjustments: Medicare holds back 2% of the payment, and hospitals can get this money back by doing well compared to other hospitals or their past performance.

3). Hospital Readmissions Reduction Program (HRRP)

The Hospital Readmissions Reduction Program (HRRP) started in 2010. This program focuses on reducing the number of patients who have to go back to the hospital soon after they leave. It looks at conditions like heart failure, pneumonia, and lung diseases (COPD).

If a patient needs to return to the hospital quickly, it can show that the hospital didn’t do enough to help them get better after they left. This program helps hospitals improve care to avoid these unnecessary readmissions.

Example: A hospital helps heart failure patients avoid going back to the hospital by checking if they take their medicine properly, offering follow-up calls, and giving access to online doctor visits. This leads to fewer readmissions and better patient care.

How it works?

Targeted Conditions: The program watches for readmissions related to conditions like heart failure and pneumonia, checking if patients need to return to the hospital within 30 days.

Payment Reductions: Hospitals with too many readmissions could lose up to 3% of their Medicare payments.

4). Hospital Acquired Conditions (HAC) Reduction Program

The Hospital Acquired Conditions (HAC) Reduction Program is a Medicare program that encourages hospitals to reduce infections or injuries that patients might get while staying in the hospital. These are called hospital-acquired conditions (HACs) because they happen during a hospital stay, not before.

Example: A hospital creates a rule to stop infections caused by medical tubes (called catheters). They make sure the staff follows strict guidelines for cleaning and using catheters. This reduces infections, keeps patients safer, and helps the hospital avoid losing money.

How it works?

Measures: Hospitals are judged on how well they prevent infections and injuries, such as bloodstream infections from tubes (called CLABSI), infections from surgeries, and bed sores (also known as pressure ulcers).

Payment Adjustments: Hospitals that score poorly on these measures may have their Medicare payments reduced. Hospitals in the lowest-performing group get less money.

5). Skilled Nursing Facility Value-Based Purchasing (SNFVBP)

The Skilled Nursing Facility Value-Based Purchasing (SNFVBP) program rewards nursing homes or skilled nursing facilities (SNFs) that work to improve patient care and reduce hospital readmissions. A skilled nursing facility is a place where people go to receive more care than they would at home but don’t need to stay in a hospital.

Example: To keep patients from going back to the hospital, a nursing facility sets up a program that includes reviewing patients’ medications and providing physical therapy. This reduces how often patients are readmitted to the hospital, and the nursing facility earns a bonus for their good work.

How it works?

Scoring Metrics: The facilities are scored based on how many of their patients have to go back to the hospital and how much they improve patient care.

Incentives: Skilled nursing facilities that perform well can earn some of the 2% of their Medicare payments that are held back until they prove they are providing good care.

6). Home Health Value-Based Purchasing (HHVBP)

The Home Health Value-Based Purchasing (HHVBP) program was started to improve the quality and efficiency of home health care, which is care provided at a patient’s home instead of a hospital. The program helps encourage home health agencies to provide better care for patients while reducing costs.

Example: A home health agency adds virtual physical therapy sessions (using video calls) along with in-person visits. This helps patients improve their movement and reduces the need for hospital visits. As a result, the agency gets higher payment because of their good performance.

How it works?

Performance Metrics: Home health agencies are evaluated on how well they help patients improve their ability to move, how quickly they start care, and how often their patients end up in the hospital.

Payment Adjustments: Agencies can either earn more money or lose some payments based on how well they perform. Payments can be increased or decreased by up to 7% depending on their scores.

7). Value Modifier (VM) Program to MIPS

The Value Modifier (VM) Program was replaced by MIPS (Merit-based Incentive Payment System) under the Quality Payment Program starting on January 1, 2019. This program adjusts how much Medicare pays healthcare providers based on their performance in four key areas: quality, cost, improvement activities, and technology use.

In simple terms, the better a healthcare provider does in these areas, the more they can earn. Providers who score well can get extra payments from Medicare, while those with lower scores may receive less.

Example: A medical group starts using electronic health records (EHR) to better organize and share patient information between doctors. This improves the quality of care and communication. As a result, they score high on MIPS, especially for interoperability (how well their systems share information with other providers) and quality. They then earn positive payment adjustments.

How it works?

Scoring Categories: MIPS scores healthcare providers based on four categories:

Quality: How well the provider cares for patients (e.g., reducing infections, improving recovery times).

Cost: How efficiently the provider uses resources, meaning they can provide care without overspending.

Improvement Activities: Actions taken by the provider to improve patient care, such as offering better patient education or using new treatments.

Promoting Interoperability: How well the provider uses technology, like electronic health records (EHR), to share patient information with other doctors or hospitals. This makes sure all providers involved in a patient’s care are on the same page.

Incentives: Providers receive payment adjustments based on their overall score. A high score means they may get additional payment, while a lower score can result in a reduction of their payments.

What are Value-Based Payment Models in Healthcare?

The healthcare system has been transitioning from traditional fee-for-service models, which reward the quantity of services delivered, to value-based payment models that prioritize quality, efficiency, and patient outcomes.

These models encourage better care coordination, reduce healthcare costs, and improve patient experiences.

For healthcare providers, understanding how these models work, their advantages, and their challenges is critical to success.

1⃣ Accountable Care Organizations (ACOs)

Accountable Care Organizations (ACOs) are groups of healthcare providers—including doctors, hospitals, and other health professionals—who work together to give coordinated care to a specific group of patients. These organizations come together voluntarily to make sure patients, especially those with long-term or chronic conditions, receive the best care possible.

Example: Imagine a person with diabetes. An ACO might have a primary care doctor, a specialist, and a hospital working together to monitor the patient’s blood sugar, offer advice on diet, and prevent complications that could lead to hospitalization. By coordinating care and avoiding unnecessary tests or hospital visits, the ACO reduces costs. If the ACO saves money while keeping the patient’s care quality high, it can keep a portion of those savings.

The main goal of ACOs is to provide the right care at the right time. This reduces unnecessary treatments or mistakes in patient care, and ensures that patients, especially those with chronic diseases, are looked after in a coordinated way.

How It Works?

Healthcare providers in an ACO work together to improve the overall health of their patients.

If the ACO can provide high-quality care while lowering costs, it can share in the savings with Medicare or other insurers (private health insurance companies).

There are different types of ACO models, including:

➜ Medicare Shared Savings Program (MSSP): This model allows ACOs to share savings based on their performance. There are different tracks, where some ACOs share only the savings, while others share both savings and risks (if costs go over a set amount).

➜ ACO REACH Model: This model focuses on fairness and health equity. ACOs in this model can create plans to reduce health care gaps for disadvantaged groups, and share financial risks with insurers.

➜ Vermont All-Payer Model: In this model, all insurers, including Medicare, Medicaid, and private insurance, work together to coordinate payments for patients across the entire state.

Advantages of ACOs

ACOs focus on preventing illness and managing chronic diseases, like diabetes or heart disease, to avoid costly treatments later.

ACOs aim to align financial rewards with better patient outcomes. This means that if the ACO keeps patients healthy and reduces costs, they can earn part of the savings.

ACOs promote teamwork between doctors, specialists, hospitals, and other healthcare providers to improve patient care and avoid unnecessary treatments.

Disadvantages of ACOs

Setting up an ACO requires a significant investment in data systems and care coordination to track patient care and outcomes. Smaller practices may find it difficult to afford these upfront costs.

In some ACO models, especially those that share losses (downside risk), healthcare providers can face financial challenges if they don’t meet cost-saving targets. This can be especially hard for smaller practices.

2⃣ Capitation Payment Model

The Capitation Payment Model is a payment system in healthcare where providers (like doctors or hospitals) receive a set amount of money per patient for a specific period of time, no matter how many services the patient needs.

Example: Let’s say a Health Maintenance Organization (HMO) pays a primary care doctor $500 every year for each patient they manage. This payment is fixed, so if the patient only needs $300 worth of services in that year, the doctor keeps the remaining $200. But if the patient needs more expensive care, like $700 worth of services, the doctor is responsible for covering the extra $200 cost.

In this model, the payment is based on how much healthcare the provider expects the patient to need over time. The goal is to encourage providers to keep patients healthy and manage their care costs efficiently.

How It Works?

Payments Based on Healthcare Needs: Payments are calculated based on what healthcare services a provider expects to deliver to a specific group of patients.

Primary Capitation: In this case, primary care doctors get paid directly to manage their patients’ overall health, from checkups to treatment.

Secondary Capitation: This covers payments for specialists, labs, and other services that go beyond primary care.

Advantages of Capitation for Providers

Since the doctor or healthcare provider gets a fixed amount of money, it simplifies billing. There’s no need to track every individual service for each patient.

Providers are encouraged to offer care in a way that reduces unnecessary services and costs. They’re incentivized to make sure patients stay healthy without wasting resources.

Since the doctor gets the same payment whether the patient needs a lot of care or not, there’s an incentive to focus on preventive care—like regular check-ups and lifestyle advice—to avoid expensive treatments in the future.

Disadvantages of Capitation for Providers

Since the provider gets a fixed amount, they might try to avoid offering too much care to stay within their budget. This could lead to under-delivery of care, where some patients don’t get all the services they actually need.

Patients may face limitations in what services are covered under the capitation agreement. If a service isn’t included in the agreement, they may not have access to it unless they pay extra.

Patients who have serious health problems (high-risk patients) can use up more of the budget, potentially putting a strain on the provider’s resources and affecting care for other patients.

3⃣ Bundled Payments

Bundled payments are a type of payment system where healthcare providers receive one fixed payment that covers all services related to a specific treatment or condition. Instead of paying separately for each service, everything needed for a patient’s treatment is combined into one price.

Example: For a hip replacement surgery, a bundled payment might cover everything from the surgery itself, to the hospital stay, physical therapy, and follow-up visits. If the total cost of all these services is lower than the bundled payment amount, the provider gets to keep the savings. However, if the cost goes over the payment, the provider is responsible for covering the extra cost.

This system encourages healthcare providers to work together to deliver efficient, high-quality care for the entire treatment process, whether it’s a surgery or managing a chronic condition.

How It Works?

There are different models for bundled payments:

Model 1: Covers just the hospital stay during the treatment (e.g., surgery).

Model 2: Includes the hospital stay as well as post-acute care (care after discharge, like physical therapy) for up to 90 days after the patient leaves the hospital.

Model 3: Focuses on post-acute care services after a hospital stay, like physical therapy or rehabilitation.

Model 4: Provides a single, upfront payment that covers all inpatient services, including everything a patient needs during their hospital stay.

Advantages of Bundled Payments

Bundled payments encourage providers from different specialties (like surgeons, physical therapists, and hospitals) to work together, ensuring the patient receives continuous care throughout their treatment.

Providers are motivated to offer more efficient care and focus on improving quality since they are rewarded for reducing unnecessary treatments and costs.

By encouraging providers to reduce unnecessary services and complications, bundled payments can lower overall healthcare costs for both patients and insurers.

Disadvantages of Bundled Payments

To manage bundled payments effectively, providers must have good infrastructure in place to track services and manage care. This can be difficult and costly to set up.

If the total cost of care exceeds the bundled payment amount, the provider must absorb the extra cost, which can be risky for them financially.

In cases where patients have complications or require additional, unexpected care, bundled payments might not provide enough flexibility. Providers might be less willing to offer extra care if it’s not covered by the payment.

4⃣ Patient-Centered Medical Homes (PCMH)

Patient-Centered Medical Homes (PCMHs) are healthcare models where the focus is on providing comprehensive care that centers around the patient’s needs. This care is delivered by a primary care team that includes not only doctors, but also specialists like dietitians, social workers, and nurses. The team works together to provide coordinated, continuous care to improve patient health.

Example: For a patient with high blood pressure (hypertension), a PCMH would involve a team of healthcare professionals, such as a primary care doctor, a dietitian, and a social worker. They would work together to help the patient take their medication properly, make healthy lifestyle changes (like improving diet and exercise), and have regular follow-up visits. This teamwork helps prevent serious health problems, improves the patient’s health, and reduces the need for hospital visits.

PCMHs aim to focus on prevention, managing chronic diseases like diabetes or hypertension, and making sure all the patient’s healthcare needs are met through coordinated care.

How It Works?

Providers who adopt PCMH standards are rewarded with incentives like financial rewards or bonuses. These rewards are given for meeting specific goals related to the quality of care and patient satisfaction.

Payment models for PCMHs can include:

• Care management fees (for the time and effort spent managing a patient’s care)
• Shared savings (providers share in the savings if they reduce costs while maintaining or improving care quality)
• Performance bonuses (extra payments for meeting quality care targets)

Advantages of PCMHs

Since the care is patient-centered and coordinated by a team, it often leads to better health outcomes and happier patients.

By focusing on prevention and managing chronic conditions, PCMHs can reduce the need for hospitalizations and emergency room visits.

Patients get to know their healthcare team well, building trust and better communication, which can improve overall care.

Disadvantages of PCMHs

Setting up a PCMH requires investing in technology (like electronic health records) and staff training to make sure the team works efficiently together.

Success depends on the patient being actively involved in their care. If patients don’t follow through on recommended treatments or lifestyle changes, the model may not be as effective.

Maintaining PCMH standards requires a lot of paperwork and documentation, which can be time-consuming for providers.

5⃣ Shared Savings and Risk Model

The Shared Savings and Risk Model encourages healthcare providers to lower costs while maintaining or improving the quality of care. This model involves two parts: shared savings and shared risk.

Shared savings means that if a provider (like a hospital or doctor) reduces healthcare costs below a certain benchmark (a target or standard), they get to keep a portion of the savings.

Shared risk means that if costs go over the benchmark, the provider must pay back some of the extra costs.

Example: Imagine a hospital that reduces readmissions (when patients have to return to the hospital soon after discharge) by providing follow-up calls and telehealth monitoring after the patient leaves. If these efforts help keep costs lower than expected, the hospital gets to keep part of the savings.

However, if the hospital’s efforts fail and readmissions rise, causing costs to go over the benchmark, the hospital would have to pay part of those extra expenses back in a shared risk model.

How It Works?

➜ A benchmark is set, which is a target for how much a provider should spend and the quality of care they should deliver.

➜ Providers who meet the quality targets and keep costs below the benchmark can share in the savings (they get part of the money saved).

➜ In downside-risk models, if the provider’s costs go over the benchmark, they must repay a portion of the extra costs.

Advantages of Shared Savings and Risk Models

Providers are motivated to lower costs and improve care quality because they can earn a share of the savings.

Providers have the freedom to manage the health of a population in a way that works best for their patients, while still focusing on cost savings and quality.

If the system performs well and lowers costs without sacrificing quality, providers can earn significant financial rewards.

Disadvantages of Shared Savings and Risk Models

In downside-risk models, if a provider doesn’t meet the benchmarks or exceeds the cost targets, they face financial penalties, which can be a challenge for underperforming organizations.

To track and monitor performance accurately, providers need sophisticated data systems to manage costs, quality, and patient care efficiently.

Conclusion

Value-based payment models are changing how healthcare is provided and paid for. Instead of paying for each service separately, these models focus on giving better care and getting good results for patients. This helps save money and rewards doctors and hospitals for doing a good job.

However, these models can be challenging because they come with financial risks and need big changes in how healthcare is managed.

Doctors and hospitals that understand and adjust to these changes can succeed and provide better care for their patients.

Burnout happens when a person feels very tired in their mind or emotions because of too much stress for a long time. Indeed, all jobs can be stressful and exhausting sometimes, but the burnout rate in healthcare is very concerning. Each year, many health workers leave their jobs completely.

Today, we will focus on our healthcare workers. We will talk about the main reasons for burnout in healthcare and how to prevent it.

The healthcare industry is very important for our society. Workers in this field do their best to keep everyone healthy and active. However, there comes a time when they also need our help and care.

As medical business operations manager, Wyatt Butler wisely states, “In the fight against burnout, we must remember that even the strongest among us need a moment to breathe.”

This blog will explain why burnout happens in healthcare, the stages of burnout, and how to solve it. Ultimately, this is to support our important healthcare workers.

Burnout in Healthcare

Many healthcare workers have felt more tired and stressed during the pandemic. During COVID-19, health workers worked hard to take care of everyone. They faced a lot of work day and night, which led to many feeling emotionally drained and burned out.

Even after the pandemic, health workers have become ever more fatigued. This is a serious concern for all of us. It can hurt the mental health of health workers and also affect their services, which can put patient care at risk.

According to the World Health Organization, burnout is an occupational phenomenon defined as a “syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”

Also, burnout is related to work and should not be used for personal stress or other life situations.

Burnout has three dimensions or significant symptoms.

1. The practitioner is always exhausted.
2. They have started keeping their distance from everyone and experiencing a lack of interest.
3. Their quality of work and efficiency are going down.

Stages of Burnout in Healthcare

Burnout is a whole process from which a person goes without realizing and ignoring the fact their mental health is affected. As Wyatt notes, “Burnout creeps in silently, and if we don’t pay attention, it can overshadow even our brightest moments.”

According to a study, burnout among health workers has increased from 2018 to 2022 relative to other industries.

The burnout rate among health workers increased in 2022, i.e., 46% compared to 32% in 2018, and is still increasing.

Teagan Stewart, a healthcare coding expert, emphasizes, “In our quest to care for others, we must also prioritize our own well-being; it’s not a weakness, but a necessity.”

It is necessary to address this issue now. There are five stages of burnout from which an individual goes and loses mental health. Let’s discuss them one by one below.

Honeymoon Phase

The Honeymoon Phase is full of excitement. When you start a new job, you become so excited about the job and try to perform various responsibilities or tasks to create a good image in the organization, even out of excitement.

Onset of Stress

When the honeymoon phase ends, you start to feel some work pressure. You may have committed so much earlier, and now you find it hard to meet the expectations, but try your best and avoid other thoughts. It is the onset of the stress stage. At this stage, some days are lively and quite stressful. You start losing your focus, and your excitement vanishes.

Chronic Stress

Now, you have become frustrated over the workload. Stress has become so continuous. It will affect your productivity and your commitment to meeting particular deadlines. You will become isolated from achieving your targets, and your relations with colleagues, friends, or family might be disturbed.

Burnout

This phase is when you no longer find joy in anything. You will hit your limit and maybe will have issues like a sad stomach, insomnia, and intense headaches. You may start doubting yourself and feel useless. As Butler states, “When joy fades from your work, it’s a sign that you need to pause and reflect.” Family members and friends can apparently observe the change in your behavior at this stage.

Habitual Burnout

Habitual burnout is when you leave yourself untreated, and then burnout becomes a permanent thing in your life. It can lead to anxiety and depression and can cause fatigue, either mental or physical. Teagan Stewart adds, “Ignoring the signs of burnout only leads to deeper issues; it’s crucial to seek help before it becomes a habit.” It is an alarming stage, and it can change your personality, and you will not be able to do your work or job anymore.

Causes of Burnout in Healthcare

Burnout has become a noteworthy issue in health workers, and it can significantly affect the quality of work and their mental health. Hundreds of reasons at work can cause burnout, such as lack of control or appreciation, workloads, and not meeting specific requirements. Below, we have discussed some prominent causes of burnout among health workers.

Administrative Burden

Administrative burdens are the leading cause of burnout in health workers. As Dr. Jennifer L. H. says, “Burnout is not just about being tired; it’s about feeling overwhelmed by the relentless administrative tasks that take us away from patient care.” When a health worker spends more time on administrative tasks than on taking care of patients, they feel frustrated. Doing paperwork, managing documents, and following up can be very tiring and take a lot of time and energy. Too much paperwork can make health workers forget about taking care of patients and feel unhappy with their jobs.

For example, submitting a medical claim takes a lot of time. First, you need to find the right codes. Then, you have to fill out all the documents and paperwork. Finally, you submit the claim with the correct coding and billing. Dr. Mike G. adds, “The constant demands of documentation and the pressures of electronic health records (EHR) contribute significantly to physician burnout.” This is not the end—following up or handling claim denials is challenging, especially when a healthcare worker has a lot to do already.

When a health worker has to do many different tasks, their job becomes very difficult. Each day, you see many patients. After each visit, you put the patient information into the computer, schedule their next appointment, and upload their current procedures. At some point, you will feel very tired from these heavy tasks and may experience burnout.

New Policies

The healthcare industry is always changing. New rules, procedures, and codes come out often. This can be very stressful for healthcare workers. They have to manage these changes along with their usual patient care duties.

As new diseases appear, healthcare workers need to learn new coding systems, such as CPT codes, to correctly document and bill for patient treatment. In 2020, during the COVID-19 pandemic, many new codes were made just for coronavirus testing and treatment. Healthcare workers needed to learn these new codes fast while also handling the increased work during the pandemic.

Similarly, when outbreaks happen, like the Measles Outbreak of 2024, healthcare facilities quickly work to learn new rules and coding procedures. Workers need to quickly adjust to new protocols and documentation standards. This ongoing change is tiring for the healthcare facility, thus causing burnout among healthcare workers.

So the added stress of extra workload and responsibility under emergency conditions can result in burnout. Healthcare workers can only handle a limited amount of change at one time before they feel drained.

Technological Challenges

Electronic health records (EHRs) and other healthcare software were created to help healthcare workers do their jobs more easily. But many find these new technologies challenging to use. The systems are often hard to use and clunky, needing a lot of time and work to put in patient information. This can increase the already large workload of healthcare workers.

Additionally, many doctors and nurses did not grow up with this kind of technology. Baby Boomers and even Millennials can struggle to adapt to modern healthcare software. For those used to paper charting systems, the switch to EHRs can be hugely stressful. Having to learn these new skills later in their careers, while still seeing a full load of patients, leaves many feeling overwhelmed.

High Patient Expectations

Today, patients expect more from the healthcare system. Patients want good care and personal attention from their doctors. But, trying to meet these high expectations can cause a lot of stress and exhaustion for healthcare workers.

One main reason for this is the change from a fee-based care model to a value-based care model. Before, healthcare providers received payment for each patient they treated. Now, they are assessed and compensated according to the care quality they give. Healthcare providers need to spend more time with each patient to make sure they follow the quality standards of the healthcare industry.

But, when healthcare providers spend more time with each patient, they can see fewer patients in one day. This can greatly affect their financial goals because they might not earn as much money as they did with the fee-based care model.

Also, the need to keep a good image and meet patients’ needs can make healthcare workers put in more hours and work harder. This can cause stress and tiredness, as they might feel too much pressure and not appreciated.

Wyatt reflects, “In value-based care, the drive for exceptional patient outcomes can sometimes overwhelm physicians, as seen in the stress of meeting stringent performance metrics.”

To maintain a balance between providing quality care and meeting financial goals, healthcare providers may feel like they are constantly juggling competing priorities. This can lead to feelings of dissatisfaction and a lack of fulfillment in their jobs.

Merit-based Incentive Payment System (MIPS)

The Merit-based Incentive Payment System, or MIPS for short, is also a big cause of burnout in healthcare. MIPS ties doctors’ payments to how well they do on certain measures of quality, cost, and more. To get the full 9% bonus payment, doctors have to score very high. This puts tons of pressure on them.

Doctors end up spending lots of extra time on paperwork and tasks that have nothing to do with helping patients. They have to do this just to get a good MIPS score. All the focus on numbers and scores takes away from real patient care, which is what most doctors went into medicine for.

On top of that, MIPS rules are super confusing and change every year. Trying to keep up causes lots of stress and anxiety. Doctors feel like they can’t win no matter how hard they try. In the end, MIPS leads to frustration, exhaustion, and burnout. It makes doctors feel like widgets in a factory rather than real human beings.

Medicare Reimbursement Cuts

Medicare reimbursement cuts are also a major driving force behind the burnout crisis in healthcare.

You see, instead of receiving raises or bonuses, healthcare workers have actually been earning less money from insurance companies for the past five years. And get this: by 2025, their pay is expected to drop by another 2.8% compared to 2024! That’s a pretty big cut, going from $36.09 in 2020 to $32.36 in 2025 per patient they see.

Now you might be thinking, “Well, they can just see more patients then, right?” But here’s the catch – they’re already being pushed to see more patients in less time to make up for the lower payments. And doing that affects their performance scores under the MIPS.

Basically, MIPS measures the quality of care they provide, and if they rush through too many patients, their scores drop. And low MIPS scores mean even lower payments down the line. It’s a vicious cycle.

On top of that, having to cram in more patients every day takes a serious toll on their mental and physical health. They’re stretched thin, overworked, and constantly stressed out.

So you can imagine how demoralizing and demotivating it must feel for healthcare workers. They’re putting their nose to the grindstone, sacrificing their well-being, and what do they get in return? Pay cuts, year after year. It’s no wonder they end up feeling burnt out and disillusioned with their jobs.

5  Effective Ways to Manage Work Stress

We all understand that at some point, work becomes a disaster for our mental health as we lose our work-life balance, and excessive workload causes us stress that leads to burnout and further anxiety or depression. But we should know that help is available anytime, anywhere.

There are many ways to reduce stress that leads to a healthy lifestyle and healthy mind. So, let’s discuss a few of them and make sure to implement them in your daily routine.

1). Exercising

As a healthcare provider, it is important to prioritize your own health and well-being, especially when dealing with the daily stressors of the job. One of the best practices to keep yourself healthy, happy, and motivated is through exercising.

In fact, according to a university survey of 185 students, doing physical activity twice a week helps in managing stress. This could include anything from going for a jog, hitting the gym, or even taking a yoga class.

In addition to managing stress levels, exercising and other physical activities can also result in good, healthy sleep, which is essential for healthcare providers who need to be well-rested and alert on the job.

But why stop at just exercising? Combining physical activity with mindfulness practices like yoga or meditation can help your mind think positively and relax your muscles. And don’t underestimate the power of a simple morning walk – even just 15 minutes can leave you with fresh thoughts and offer a fresh start to your day.

2). Outsourcing your Work

In today’s fast-paced world, working smarter, not harder, is the key to success. When you hire someone else to handle your administrative work, like medical billing, coding, accounting, managing revenue, and submitting claims, you can save important time and energy. This allows you to focus on what is really important – giving great care to your patients.

Partnering with a good medical billing company can make a big difference. These professionals know their work well. They are committed to making sure your administrative tasks are done quickly and correctly. When you outsource these tasks, you can make your work easier and feel less stress.

One main benefit of outsourcing is that it helps you get back your time. Rather than spending many hours on administrative tasks, you can use that important time for your health, continuing education, or just taking a needed break. This new balance can help stop burnout and support a healthier, more lasting work-life situation.

Also, outsourcing agencies focus on keeping high efficiency and quality. They use teams of skilled workers who know the latest rules and best ways to do things in the industry. They have the skills and resources to handle your administrative tasks well.

Outsourcing does not have to be very expensive, despite what many people think. Many trusted agencies provide affordable services, so you can enjoy the advantages of outsourcing without hurting your budget.

3). Seeking Counseling

Getting counseling is a great way to fight burnout and get back your love for healing. Rather than isolating yourself, talk to coworkers who understand what you are going through. Dividing duties more evenly, changing schedules for personal time, and discussing frustrations can help a lot.

You might not want to show your feelings or say that you are struggling. But the hallmark of a great healthcare provider is recognizing when they need care too. Counseling helps you deal with difficult experiences, handle worries, and regain perspective. You need to take care of yourself sometimes if you want to help others.

Take care of yourself by seeking counseling now. This can help you avoid burnout that can harm your health and job. Your coworkers and patients rely on you to perform well. Asking for help shows bravery and smart thinking. It will help you keep giving great, caring support while also taking care of yourself.

4). Having Enough Sleep

Not getting enough sleep can make the high stress levels that healthcare workers feel even worse. If you do not get enough rest, your mind has a hard time recovering. You may start to overthink things, and your health can get worse. Doctors say adults should sleep 6 to 8 hours each night for good health and brain function. There are several effective ways healthcare workers can promote sufficient sleep:

First, make a space that is good for sleeping. Dim the lights, play calm music, turn off electronic devices, and make sure the bedroom is quiet, cool, and cozy. This tells the brain and body that it is time to relax and rest.

Next, create a regular routine before bed. This can include taking a warm bath, reading a book, or doing some light stretches. These activities help you move from being awake to sleeping. Do not do things that make you excited, like exercising, working, or using screens, right before you go to sleep.

In addition, mindfulness activities such as meditation or deep breathing can help lower stress and calm busy thoughts. Doing these during the day or before sleep can reduce stress and racing thoughts that disrupt sleep. Other lifestyle habits, such as exercising regularly, getting sunlight, drinking less caffeine, and eating healthy foods, also help improve sleep quality.

5). Taking a Break

Excessive work and the same robotic routine for days make you exhausted and frustrated. In that case, a short vacation to the beach, mountains, island, or anywhere you like can help.

Take your annual leaves and plan a tour with your family or friends to have some quality time with loved ones. It will definitely help you start fresh with a positive mind set.

Here we will share some common provider payment systems used in healthcare. So you can pick what is right for your needs. The goal is to find a simple, smooth way to get the money you earn. With the best fit, you will get paid promptly and properly.

1). Fee-for-Service Method

Fee-for-service (FFS) is the usual way to pay for healthcare. Doctors and hospitals get money for each service they give patients. They set rates ahead of time for all kinds of care. Since they earn more by doing more, this makes them want to provide extra services.

FFS is the easiest and longest-used payment method. Most doctors like it because it gives them the most money back. Under this model, there are no bundled payments. Doctors get paid for each visit or hospital stay. While this model helps doctors, it also has some downsides for them to think about. For instance, FFS may lead to fragmented care since providers are paid for volume over value.

Example: A patient has a skin rash. The dermatologist looks at the rash and performs a biopsy to test for skin cancer. The patient is billed for the office visit, skin biopsy, and pathology analysis of the biopsy.

2). Capitation Method

Capitation is a simple payment method. Doctors get a fixed fee each month for each patient. This fee covers all care for the patient. The doctors get paid before giving any care.

With capitation, the health plan and doctors agree on a monthly fee for each patient. This fee pays for hospital stays, clinic visits, drugs, and doctor checkups. Doctors get the monthly fee upfront.

By taking a capitation fee, doctors take on some money risk. They must provide care within the fixed capitation fee. But this makes them focus on keeping patients well and coordinating care. Overall, capitation aims to cut costs and align doctor interests with high-quality care.

Example: ABC Health Insurance agrees to pay Dr. Johnson $50 per patient per month to provide basic medical services. Dr. Johnson receives the $50 on the 1st of each month for each patient enrolled, regardless of whether they visit that month.

3). Episode or Case-Based System

In a care model based on Episodes or Cases, doctors get a fixed payment for all services given during a patient’s care period. This bundled payment is decided upfront based on the patient’s illness and needed treatment plan. It covers the whole cost of care from the time the patient is admitted to when they are discharged.

Extra procedures or services during this time may raise costs. But under the bundled payment model, this risk moves to the doctor. The doctor must manage the total costs of the episode within the fixed bundled payment amount. This encourages efficient care.

Overall, episode-based payments aim to reduce fragmented fee-for-service payments and promote coordinated care for the patient during their whole treatment journey.

Example: A hospital receives $10,000 for a knee replacement surgery. If the patient has to be readmitted within 90 days for a complication from the surgery, the hospital does not receive additional payment for the readmission.

4). Global Budget Payment Method

Hospitals receive a fixed total payment per year in the Global Budget system. The payment is set beforehand. If a hospital provides less services than predicted, their budget will be reduced for that year. However, they will receive a higher payment the following year to compensate.

This method assists in stabilizing service volume and a hospital’s market share. Payers can gradually decrease the budget and service volume of less productive or underutilized hospitals. They do this if excess capacity exists in the provider network.

Example: BMD Hospital received a $10 million global budget for the year. They ended up providing fewer services than expected, so their budget was decreased to $9 million the following year. However, if BMD Hospital exceeds their reduced budget the next year, their funding will be increased again to compensate.

5). BellMedEx Provider Payment Solutions

BellMedEx provides cutting-edge payment solutions tailored to healthcare groups. Their patented systems quickly and accurately pay providers for care.

The company’s automated system reimburses providers electronically after each patient visit. It is customized to the practice type, facility and care model. Whether a small private practice or large hospital, they have a solution.

This medical billing company leads the industry in payment systems. They closely track all reimbursements, manage claim denials and oversee revenue cycles. They use electronic tools like EFTs and clearinghouse links to maximize efficiency.

With this innovative system, providers get paid fast. The company handles everything so practices get prompt payment. The customized services make them the top choice nationwide for improving payment operations.

Other Provider Payment Methods in the US Healthcare

There are some basic payment types used in healthcare. Each type is defined by what unit it pays for. This could be a service, episode, condition or population. These types are more specific than general terms like fee-for-service or capitation. They also divide financial risk between the payer and provider. Each type reflects a risk factor in healthcare spending. The payment types balance cost control and quality care in different ways. Understanding them is key to evaluating payment reform ideas.

6). Per Time Period

Providers receive a predetermined payment for a set period (e.g., monthly, quarterly, or annually).

Application:

• Commonly used in capitation models where providers are paid per patient per month (PMPM) to cover all necessary services.
• Also used in global budgets where a healthcare organization receives a fixed budget to manage all patient care within a specific time frame.

Example:

In a capitation model, a primary care physician might receive $50 per patient per month. This payment covers all primary care services for that patient, regardless of how many visits or treatments the patient requires during the month.

7). Per Beneficiary

Providers are paid a fixed amount for each enrolled beneficiary, typically on a monthly or annual basis.

Application:

• Commonly used in managed care organizations and health maintenance organizations (HMOs).
• Encourages providers to focus on preventive care and efficient management of chronic conditions to avoid costly interventions.

Example:

In a capitation model, a healthcare provider might receive $100 per month for each patient enrolled in their care.

8). Per Recipient

Payment is made for each individual recipient of a specific service or set of services.

Application:

• Often used in public health programs and specialized care settings.
• Helps ensure that providers are compensated for each patient they serve, promoting access to necessary services.

Example:

A mental health clinic might receive a fixed payment for each patient receiving therapy sessions, regardless of the number of sessions.

9). Per Day

Providers are paid a fixed amount for each day a patient is under their care.

Application:

• Common in inpatient settings such as hospitals, nursing homes, and rehabilitation centers.
• Ensures that providers are compensated for the duration of care, but may incentivize longer stays.

Example:

A nursing home might receive a daily rate for each resident, covering all services provided during their stay.

10). Per Dollar of Cost

Providers are reimbursed based on the actual costs incurred in delivering care.

Application:

• Used in cost-reimbursement models, often in public healthcare programs.
• Ensures that providers are compensated for their expenses but may lack incentives for cost control.

Example:

A hospital might be reimbursed for the cost of supplies, staff time, and other expenses related to a patient’s treatment.

Conclusion

As a healthcare provider, whether you are an individual, small practice or a hospital, you need a transparent and smooth payment mechanism. We hope these common payment methods enable you to choose the right one for your practice or facility.