Majority of High-Earning Physicians Use Fee-for-Service
Experts are calling for physicians to use their power to force a shift to value-based care instead of fee-for-service.
- The biggest argument against the widespread fee-for-service healthcare payment platform is that it incentives practitioners to order more tests instead of take more patients to make more money. The potential for abuse of this system has been the driving force behind healthcare payment reform in recent years and the focus on a value-based platform.
However, according to a study earlier this year from the Centers for Medicare & Medicaid Services, high-earning physicians are paid more because of the number of services they provide to beneficiaries and not by the number of patients they treat. Experts and regulators see this as a problem.
Many of these concerns were expressed in a research letter for the Journal of the American Medical Association – Internal Medicine, penned by a research team from the UCLA Department of Urology and the Veterans’ Health Administration consisting of Jonathan Bergman, MD, MPH; Christopher Saigal, MD, MPH; and Mark Litwin, MD, MPH.
The group examined data released by CMS which reviewed Medicare Part B payments from 2012. With the push toward value-based care, the findings in the data are characterized as “very surprising.”
According to the letter, Medicare spending is the biggest factor crowding out investment opportunities in all other social priorities. It is also important to navigate because of the potential impact on public policy. Alternative payment models aim to reduce the harmful financial incentive to perform more services and procedures. This is where the bundled payment initiative and Shared Savings Program.
“With clinicians making more not by seeing more unique patients, but by providing more services per person, additional research needs to be done to determine if these additional services are contributing to improved quality of care,” the letter reads. “These findings suggest that the current health care reimbursement model – fee-for-service – may not be creating the correct incentives for clinicians to keep their patients healthy. Fee-for-service may not be the most reasonable way to reimburse physicians.”
The findings suggest a weakness in the fee-for-service approach. It makes more sense to reimbursing clinicians for providing high quality care or for treating more patients instead of focusing on the number of services and tests they have a patient have.
The goal of payment reform, in terms of improving quality, are still unrealized. The letter mentions that physicians take an oath to care for patients “using appropriate means and appropriate ends.” These means always focusing on what is best for the patient.
“This centuries-old oath still resonates with graduates of medical school classes,” the research letter states. “Rather than react to externalities imposed by payers, clinicians can lead the movement toward a high-value, patient-centered care. We are uniquely empowered to ensure that all individuals access the procedures they need, and are not exposed to those they don’t.”
