Effort to Move Doctors’ Pay Away from Volume Finds Obstacles

Feb. 14, 2022 – Doctors are nonetheless largely paid by what number of sufferers they see and providers they supply, regardless of years of discussions about pegging their pay to judgments in regards to the high quality of the care they ship, in line with the authors of a brand new research.

Volume-based pay was the commonest sort of base revenue for greater than 80% of major care docs and for greater than 90% of specialists in a pattern studied by Rachel O. Reid, MD, of Rand Corp., and co-authors. They revealed their findings Jan. 28 in JAMA Health Forum.

Their research examined the pay in 31 physician teams that work with 22 U.S. well being methods. The percentages of complete physician compensation based mostly on high quality and price efficiency judgments have been “modest,” at 9% for major care suppliers and 5% for specialists, the researchers discovered.

These findings could also be a “solid reality check” on progress in shifting the U.S. observe of drugs towards what are referred to as value-based preparations, Reid tells WebMD.

Their findings are much like earlier research. In 2016, for instance, researchers working for the federal Agency for Healthcare Research and Quality reported that 94.7% of U.S. physician workplace visits have been lined beneath some type of fee-for-service plan in 2013.

‘Beautiful Rhetoric’

There has been a lot speak lately about the necessity to tie docs’ pay to the standard of care sufferers obtain. In idea, there may be broad settlement about the advantages a shift away from the fee-for-service mannequin might present.

The Affordable Care Act of 2010 additionally included methods to encourage well being care methods to contemplate adjustments of their strategy to care.

In the years after the Affordable Care Act handed, dialogue centered on the necessity for cost based mostly on high quality of care, as an alternative of an a la carte system, which would offer a motive for docs to layer on providers, says Frederick Isasi, JD, the chief director of the left-leaning client advocacy group Families USA.

Leaders of well being methods will typically handle this theme of value-based cost of their public talks, he says.

But work from researchers like Reid and her co-authors reveals how little progress has been made in turning this into actuality.

“There’s lots of beautiful rhetoric, but this study shows that 12 years later, we’re still stuck in the same place,” Isasi says.

While the outcomes of Reid’s paper can be “100% predictable” for anybody who understands the financing of well being care within the United States, they might be “truly shocking” for most individuals, he says.

‘Fee-for-Service Chassis’

One motive for the sluggish tempo of development in value-based cost preparations is that a lot of them are rooted within the older strategy to reimbursement, Reid tells WebMD.

“A lot of the alternative payment models that are out there are built on a fee-for-service chassis where attribution happens on the basis of fee-for-service claims, or it’s a shared savings model on the basis of fee-for-service billing,” Reid says.

This research was half of a bigger Rand Health System research, wherein in-depth interviews have been accomplished with senior officers with well being methods in 4 states (California, Minnesota, Wisconsin, and Washington). These states have been chosen to symbolize variation within the U.S. market, however the discovering might not generalize to different areas of the nation, Reid and co-authors be aware.

Gary Young, JD, of Northeastern University, additionally cited this as a limitation of the paper. In an interview, he additionally famous that the Reid paper addressed a few of the hurdles which have slowed the adoption of value-based cost, akin to points with makes an attempt to determine measurements of high quality of care.

The paper’s conclusion “isn’t that surprising, but it raises some serious considerations about why pay-for-performance, value-based payment, and alternative payment arrangements have not diffused through the system more deeply,” he says.

The paper Reid and co-authors revealed final month in JAMA Health Forum supplies a snapshot of 1 a part of the controversy about how docs are paid, focusing in on the persistence of the fee-for-service strategy.

But Reid is also among the many researchers who’ve studied the results on sufferers of a fee-for-service strategy to medical care, as is Young, who’s director of the Northeastern University Center for Health Policy and Healthcare Research.

Reid, for instance, is among the authors of a 2021 paper in JAMA Network Open that reported on the persistence use of remedies thought of to be of low worth to sufferers regardless of main efforts to make docs and customers conscious of issues about them. In that paper, Reid and co-authors stated low-value care use and spending had decreased solely marginally from 2014 to 2018 amongst individuals enrolled in conventional Medicare.

Young says many customers are typically extra frightened about adjustments in well being care that might restrict their entry to providers.

“They may even say ‘Look, I’m happy to have my provider be more incentivized to give me more,’” Young says.

But they could not think about how this strategy raises medical health insurance prices typically or the way it can put them in danger for ineffective and pointless remedies, in line with Young. He is among the authors of a 2021 paper within the journal Health Affairs that discovered the percentages of a affected person receiving an inappropriate MRI referral elevated by greater than 20% in instances the place docs had transitioned to hospital employment.

Young and his co-authors stated they discovered most sufferers who acquired an MRI referral by a hospital-employed physician had the process on the hospital the place the referring physician was employed, Young and his co-authors discovered. These outcomes thus level to the rising pattern of hospital employment of docs as a possible driver of low-value care.