Physician Practices Struggling with New Payment Models
By - As physician practices continue to utilize new healthcare payment models to increase quality and decrease costs, they are actively struggling. The way physicians and health professionals are paid by the federal government and private payers is changing, with a new focus on enhanced quality that is economically advantageous.
Physicians are attempting to best grapple the arduous task of managing substantial amounts of data as they communicate with a variety of payers, separate programs, and a range of metrics, according to a new joint study of eighty-one individuals from thirty-four physician practices by the RAND Corporation and the American Medical Association (AMA).
The study’s findings will hopefully influence the AMA’s system-wide efforts to improve alternative payment models so physicians are best acclimated to the adjustments.
“The AMA is committed to ensuring physicians in all specialties and practice sizes can participate successfully in new payment models that allow them to efficiently provide the best care to patients,” states AMA President-Elect Steven Stack, MD. “Insights from the new AMA-RAND report will provide missing information on the real-world impact of payment reforms on busy physician practices that can help improve current and future alternative payment programs.”
Researchers focused on determining alternative healthcare payment models’ effects on physicians and medical practices nationwide. Such models include episode-based and bundled payments, shared savings, pay-for-performance, capitation, and retainer-based practices. Additionally, accountable care organizations and medical homes were examined.
As physician practices pursue means of acquiring success with new payment models, many are partnering with other medical practices or hospitals and are realigning their operations to objectives of new payment strategies.
Practices express this is a challenging task – needed data is often unavailable and payment models often do not always merge seamlessly. Practices may have different performance measures tied to payment rewards.
Researchers conclude when crucial data, such as quality performance feedback, is omitted or erroneous, physician practices struggle to use data analysis to improve care and reduce spending.
According to Mark Friedberg, MD, Lead Author of the study and Senior Natural Scientist, “For alternative payment methods to work best, medical practices also need support and guidance. It’s the support that accompanies a new payment model, plus how well the model aligns with all of a practice’s other incentives, that could determine whether it succeeds.”
Researchers confirm alternative payment models impact practice stability and either neutrally or positively influence a practice financially. According to practices surveyed, none confirmed experiencing financial hardship because of new payment model implementation.
“While physician practices are making substantial investments in data collection, payers also should consider investing in the capability of physician practices to manage the information,” the AMA-RAND press release states. “Such investments could enhance the effectiveness of new payment models, and help medical practices make the best use of computerized health records and other health information technology, according to researchers.”
The majority of medical practices have safeguarded individual physicians from payers’ new financial incentives, researchers found. Although practices demonstrating improved performance are paid more, they commonly use nonmonetary incentives to push physicians to alter their decisions, such as providing performance feedback to individual doctors.
“Practices seem to feel more comfortable using nonfinancial incentives to encourage physicians to provide more-efficient, lower-cost care,” Friedberg says. “Despite the pressure to contain costs, practice leaders are trying to avoid creating situations where doctors are paid more when patients do not get the services they need.”
Concerns about physician burnout are alive and well, says the study. Alternative payment models have not affected the essence of physicians’ clinical work, confirms the study, which affirms efforts to improve efficiency by allocating tasks to non-physicians inadvertently amplify the amount of physicians’ work.
The report explains four key recommendations that physician practices can actively adapt to ensure future success.
First, physician practices should have adequate support and guidance to optimize the quantity and content of physician work under alternative payment models.
Second, physicians’ concerns about payment models’ operational details should be actively addressed to improve alternative payment models’ effectiveness.
Third, ensuring physician practices have data resources for data management and analysis will ensure success with alternative payment models.
Lastly, harmonizing components of alternative payment models, i.e. performance measures, will help physicians respond constructively.
