Recent Trends in Medicare Reimbursements

Professional health care providers in direct contact with patients have been required to be licensed and credentialed demonstrating current competencies of quality and safe healthcare practice.

Should similar licensing and credentialing requirements be imposed on collaborative workers in the health care industry who may not be directly serving patients (e.g., business office personnel, CEOs, CFOs, or other administrators)? Why or why not? Collaborative health care workers should not be generally required to obtain similar licensing and credentials as their direct-patient care provider counterparts for two main reasons: redundancy and excessive costs First, requiring collaborative health care workers to obtain licensing and credentialing similar to direct patient care providers would be redundant because some collaborative health care industry executives who perform administrative tasks that do not involve direct patient care already possess professional licensing and credentials by virtue of their current occupational status and previous work experience (e.g., physicians or advanced practice nurses) (Kash, 2016), Likewise, collaborative health care executives who are certified public accountants or attorneys at law are already credentialed and licensed for practice and are typically members of national professional associations (Kranacher, 2012).

The second reason why collaborative health care workers should not be required to obtain licenses and credentials similar to those required by those providing direct patient care relates to the enormous costs that would be involved in an industry that is already operating at razor-thin profit margins and struggling to provide timely and efficacious health care services to an increasingly diverse patient base (Kaplan, 2012).

There are other costs involved in this scenario as well, including most especially the chilling effect that such an onerous requirement would have on recruiting otherwise qualified collaborative health care workers who would likely view such a requirement as not being worth the "bang for their buck" in terms of their investment of time and resources to secure a position that does not pay a commensurate salary.

In other words, talented executives and administrators who might be attracted to a career in collaborative health care might well reconsider their occupational choices if these positions required licensure and credentials that were not required by other sectors. Question 2. Credential requirements have gradually increased in all sectors of the health care arena over the past decades.

If this trend continues, for how long will health care organizations remain sustainable? Why? What steps should health care administrators take to absorb the rising credentialing requirements? Why? Since 1986, Medicare has tied health care organization reimbursements for services rendered to accreditation by the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations) which mandates credentialing for health care providers (King & Allison, 1994).

The credentialing process has been shown to be an effective strategy for continuously improving the quality of health care services provided by health care organizations of all types and sizes (King & Allison, 1994). More recently, Medicare has begun to link reimbursements to health care providers based on the quality of the services that are delivered (Linking quality to payment, 2016).

For instance, according to the Centers for Medicare and Medicaid Services (CMS), "The CMS, the federal agency that runs Medicare, is changing the way Medicare pays for hospital care by rewarding hospitals for delivering services of higher quality and higher value" (Linking quality to payment, 2016, para. 2).

This recent change in Medicare policy means that health care organizations can absorb some if not all of the costs of their credentialing function by ensuring the process is performed efficiently and is designed to ensure that all medical care providers possess the requisite licenses and credentials required for practice as well as the expertise needed for their occupational specialty (Difranco, 2000). In this regard, Difranco (2000) reports that, "Health care costs are continuing to rise. This forces hospitals to consider the cost and efficiency of each physician when making privileging.