Payment reform: complexities to consider

Providers and payers should take the following actions to prepare for imminent payment reforms from CMS and commercial payers: Adopt industry standard value-based pricing principles. Identify variations in costs, reimbursement rates, and payment terms within your managed care contracts and day-to-day operations. Establish core, evidence-based costs and payments to cover those core, evidence-based costs. Adopt new delivery tactics to manage a sustainable margin on lower unit reimbursement increases.