Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

61% of Doctors Say Value-Based Care Will Damage Their Practice

Forty-nine percent of physicians in the survey also said value-based care and reimbursement would negatively impact patient care.

Value-based care and alternative payment models

Source: Thinkstock

By Jacqueline LaPointe

- Physicians are still on the fence about the impact value-based care will have on their business and patient care, a recent survey showed.

Forty-nine percent of over 3,400 physicians recently surveyed by the nation’s largest physician-owned medical malpractice insurer, the Doctors Company, said value-based care and reimbursement will have a negative impact on patient care as a whole.

One surgeon respondent from California stated that “value-based care and reimbursement is a false assurance of good medical care.”

And another surgeon likened the transition away from fee-for-service to that of the EHR transition. “The EHR was supposed to improve care, but it has done the opposite; value-based care will likely also,” the respondent said.

Respondents also questioned if value-based care and pay-for-performance model are good for the healthcare business.

Approximately 61 percent of physicians stated that value-based care and reimbursement will have a negative impact on their practice. Another 63 percent said the transition away from volume will also have a negative effect on their earnings.

Physicians agreed that value-based care and pay-for-performance models would have the following earning consequences:

  • Creating an additional stressor to already-falling claims reimbursement rates
  • Spending more on services or partnerships to ensure quality performance success
  • Adding to documentation and data collection requirements, which results in additional costs and strains on resources
  • Causing physicians to consider a healthcare merger or acquisition

Several respondents also voiced their concerns that a lack of clear metrics for pay-for-performance models would result in physicians not being compensated fairly for their performance. One non-surgical specialist from Idaho summed it up as being “afraid that we don’t have adequate metrics to be able to accurately measure pay-for-performance and as a result it will be one more tool for payers to further tighten reimbursement for physicians.”

Physician perspectives on value-based care and reimbursement have not changed much in the past year. A 2017 Physicians Practice survey found that 46.4 percent of healthcare providers and leaders were unsure how the shift away from fee-for-service would impact their practice.

The second most comment response with 29.4 percent of respondents was that value-based care would be bad for the practice.

Healthcare executives may be warming up to value-based care and reimbursement more than physicians. A July 2018 survey revealed that 46 percent of healthcare executives and managers expect value-based contracts to improve their organization’s profitability.

The percentage of leaders expecting value-based contracts to improve the bottom line increased from just 23 percent two years before.

Physicians, however, remain skeptical about the transition to value-based care and reimbursement and that skepticism extends to their views on specific alternative payment models, The Doctors survey showed.

Only 14 percent of doctors reported plans to participate in a bundled payments model, which provide a single payment to providers for an entire episode of care. Bundled payments typically have a quality performance component tied to the reimbursement.

The majority of respondents (48 percent) said they do not plan to participate, while 18 percent were undecided, and 21 percent said they needed more information to make a decision.

Physician participation in accountable care organizations (ACOs) was also a mixed bag. ACOs are groups of physicians, hospitals, and other healthcare providers who aim to deliver coordinated, high-quality care and receive value-based reimbursement for the cost and quality of care they deliver as a group.

Forty-three percent of respondents stated that they do not plan to participate in an ACO. The remaining doctors said they plan to participate (27 percent) or are undecided or need more information (30 percent).

Older physicians were more likely to report that they were not going to participate in an ACO, the survey pointed out.

Physicians may be split on their participation in bundled payments and ACOs because they believe the alternative payment models detract from patient care.

A surgical specialist in Arkansas said, “The ever-increasing regulations, such as bundled payments and quality payment programs, take total focus off the needs of the patient and transfer focus to meeting the guidelines of these programs. What happened to patient care?”

A New Mexico-based primary care physician also told researchers that bundled payments and ACOs are not created to benefit or include the independent physician.

“Bundled and ACO-type revenues in my opinion are over-hyped and only help large system like HMOs and university practices,” the respondent told researchers.

Physicians may feel uncertain about the impact value-based care and alternative payment models will have on their practices. But industry experts are sure that the transition away from fee-for-service payments and care delivery is here to stay.


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