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Survey: Physicians Doubt New Payment Models Will Contain Costs or Improve Quality

Getting physicians on board with value-based payment models does not necessarily mean they are convinced of the efficacy of these models, according to a recent survey by Leavitt Partners.


A summary of the survey results appears below:


  • Only 20 percent of physician respondents said either bundled payments or hospital-led ACOs would contain healthcare costs.
  • Significantly less than a majority of respondents said patient health improvements likely would result from bundled payments (19 percent), ACOs (29 percent) or episode-based payments (29 percent).
  • Pluralities of physicians said they were uncertain about the patient health benefits of ACOs (46 percent), bundled payments (48 percent), capitated payments (45 percent) and patient-centered medical homes (46 percent).
  • Majorities of physician respondents said they were uncertain about the health benefits of integrated delivery networks (56 percent), episode-based payments (55 percent) and global payments (58 percent).
  • Some physicians were aware that their employer is participating in value-based payment models but saw such participation in a negative light because it is different, affects how they are paid and is of questionable value to them.
  • More likely to improve outcomes, according to physicians in the survey, are physician pay-for-performance (40 percent) and patient-centered medical homes (40 percent).
  • More likely to contain costs are an increased focus on wellness and prevention (60 percent), improved management of mental health (56 percent) and better management of heavy utilizers of care (52 percent).
  • Only 41 percent of the physician respondents were at least somewhat familiar with MACRA.
  • 37 percent said some payment models such as capitated payments negatively affect patient health outcomes


Engaging Physicians 


Although a large number of hospitals, health systems and practices are involved in ACOs and bundled payments, few frontline physicians are aware of what those organizations are doing to participate and to improve results, the lead researcher at Leavitt Partners noted.


He added that frontline physicians are frequently uninformed about the practical effects of payment models or MACRA. Such unfamiliarity usually stems from an inability of organizations that operate such models to see the value in educating participating physicians about the benefits, and a lack of time on the part of physicians to receive such education.


Effective approaches to physician engagement include reaching out to all physicians—especially at smaller organizations—through a retreat or other type of group meeting. Such outreach allows organization leaders to discuss the reasons for participating in the model, the needed changes and the potential benefits with their physicians before the payment model even has launched, the researchers wrote.


“Such an approach usually instills at least a grudging willingness to experiment and eliminates outright negative attitudes,” the lead researcher noted.  (“Few Physicians Support Value-Based Models: Survey,” HFMA Weekly, February 2, 2018)


Another effective approach to engagement has focused on starting the model with a subset of clinicians who the organization believes are most amenable to moving toward value-based arrangements. That initial group would be included for the first few years, with the organization then publicizing the results and incorporating more physicians.


(Source: “Few Physicians Support Value-Based Models: Survey,” HFMA Weekly, February 2, 2018)



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