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Clinicians Less Optimistic About Value-Based Care Than Execs

More clinicians and clinical leaders thought value-based care would not improve care quality or lower costs compared to healthcare executives.

Value-based care and value-based reimbursement

Source: Thinkstock

By Jacqueline LaPointe

- Clinicians are more skeptical about the benefits or viability of value-based care and reimbursement compared to healthcare executives, a new survey shows.

Only about one-third of clinicians (38 percent) in a recent NEJM Catalyst survey thought value-based care would significantly improve quality of care compared to 55 percent of healthcare executives. Even fewer clinicians (36 percent) believed value-based care would significantly lower cost of care versus one-half of executives.

With reservations about the benefits of value-based care, clinicians were less confident than executives that value-based reimbursement would become the primary revenue model for US healthcare, the survey of over 500 healthcare delivery system executives, clinical leaders, and clinicians revealed.

Only about 37 percent of clinicians and 39 percent of clinical leaders think value-based reimbursement will someday dominate the healthcare payment landscape, while 51 percent of executives believe the alternative payment method will take off.

“This suggests that, for many providers, the jury is still out on the benefits of value-based care,” researchers at NEJM Catalyst explained.

READ MORE: What Is Value-Based Care, What It Means for Providers?

The survey’s results mirror the findings from other research studies that show value-based care means something different to frontline clinicians and executives. For example, a recent survey of over 3,400 physicians revealed that 61 percent of doctors felt value-based care will have a negative impact on their practice, and 63 percent believe the transition away from fee-for-service will specifically negatively affect their earnings.

On the other hand, more healthcare executives are seeing the profitability of value-based care models, according to a recent KPMG survey. About 46 percent of healthcare executives and managers surveyed anticipate value-based reimbursement contracts to improve their organization’s profitability.

The healthcare industry is experiencing a disconnect between the C-suite and the frontline when it comes to value-based care and reimbursement. And the chasm may have something to do with the value-based care barriers identified by NJEM Catalyst survey respondents.

Health IT infrastructure was the top challenge to implementing value-based reimbursement models, according to the survey. Approximately 42 percent of all respondents said the information technology and health IT infrastructure requirements of value-based reimbursement hindered adoption of the alternative payment models.

Comments from survey respondents indicated that clinicians are burdened by the health IT infrastructure requirements, with the EHR system being the greatest burden.

READ MORE: Best Practices for Value-Based Purchasing Implementation

“EHR is the biggest culprit in high cost and low satisfaction,” a clinician from a large non-profit teaching hospital in the South told NEJM Catalyst. “If physicians motivated and got reimbursed for not doing things, we would save 50 percent of cost overnight. Prescribe Magic pill of ‘Talk to patient and listen’ – well, guess what, we don’t have time for that. US health system is screwed up far beyond repair, it needs overhaul in biggest way possible.”

Another clinician at a large non-profit teaching hospital in the West complained about the EHR documentation requirements of value-based reimbursement models.

“Quit making us document a ton of stuff that isn’t applicable to our particular practice and that stops us from being able to work with our patients to achieve better outcomes,” the clinician commented. “When we are having to document in the late hours of the night, or look at lab results in the late hours of the night because we have spent a good part of our day motivationally interviewing our patients to get them involved as partners in their own health care, it leads to physician burnout and lack of empathy for our patients.”

Changing regulations and policies was the second most cited barrier to value-based reimbursement implementation with 34 percent of all respondents, followed by administrative detail with 33 percent, sustainability of savings with 28 percent, and data integration with 20 percent.

Earning physician buy-in with value-based care implementation may be the key to success. Physician engagement is critical to the value-based care transition, according to the Advisory Board. And researchers at the Patient-Centered Primary Care Collaborative (PCPCC) and the Robert Graham Center identified physician buy-in as one of the top characteristics of a successful accountable care organization (ACO).

READ MORE: What a Trump Presidency Means for Value-Based Care and the ACA

“Physicians who are not aligned and engaged with their organizations have more reasons to resist new structures and systems, such as value-based payment models,” consulting firm Bain & Company explained. “By contrast, those who have a say in management decisions are much more satisfied with their working environment and more willing to lead change.”

Healthcare organizations can advance their value-based care efforts by engaging clinicians with the transition away from fee-for-service. In particular, leaders should provide a clinical rationale for changing care delivery, not just financial logic, the consulting firm advised.

Creating clinical champions can also help get clinicians involved in value-based care initiatives, PCPCC and Robert Graham Center researchers stated.


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