Short Takes On News & Events

Report: Payment Reform Leaves Docs Uneasy

By Shefali S. Kulkarni

December 7th, 2012, 2:53 PM

A new report from insurer UnitedHealth Group shows that doctors have mixed views on the new pay-for-performance model promoted in the 2010 health care law as a means of controlling health care costs and improving quality.

The law has provisions that transition from a traditional fee-for-service system, where doctors, hospitals and other providers are paid based on how many patients they served and the specific treatments or episodes of care for those patients, to new payments models that change incentives in a variety of areas. This new payment reform includes rewards for high quality care, bundled payments to cover a spectrum of providers and treatments for a patient, giving providers a set fee for managing patients care and also giving them a share of any savings.

The report estimates savings from payment reform to be anywhere from $200 billion to $600 billion over 10 years. But the report, released Wednesday at the Forbes health care summit in New York, finds misgivings among providers.

A survey of doctors by Harris Interactive finds that 59 percent of physicians believe that the fee-for-service system encourages them to provide “an appropriate level of care.” Only 15 percent disagreed. Although 37 percent of doctors thought such a system encourages the use of more care or expensive care, 38 percent also said that a fee-for-service system encourages coordination of care. Not surprisingly, the 400 U.S.-based primary care physicians and 600 U.S.-based specialists surveyed, did not favor the idea of a global capitation payment—or a fixed payment per month for all medical services. Nearly 60 percent of the doctors surveyed said that capitation put too much risk on the provider.

Furthermore, “physicians’ views did not differ substantially based on the size of their practice, even though doctors in larger practices would be less exposed to insurance risk under capitation.” Doctors also estimated that their practices get up to 68 percent of their revenue from fee-for-service payments.

Harold D. Miller, the executive director of the Center for Healthcare Quality and Payment Reform, says that policymakers can’t expect physicians to take accountability for things they can’t control or influence. “Alternative payment systems need to have appropriate risk adjustments, risk limits, and risk exclusions,” he says. “Most of the broad-based payment reforms in the Affordable Care Act, including ACOs, are just small [pay-for-performance] incentives added on  top of the existing fee-for-service system. You don’t fix the barriers and disincentives of fee-for-service by adding a new layer of [pay-for-performance] on top of it; you have to completely replace fee-for-service.”

10 Responses to “Report: Payment Reform Leaves Docs Uneasy”

  1. Paul says:

    “Report: Payment Reform Leaves Docs Uneasy”

    Docs uneasy? What the hell do you think consumers have been feeling since anyone can remember? Do you think trying to get a wart removed or trying to get a flu shot has been easy? Not to mention trying to get treatment for cancer or diabetes! Forget about it! Docs uneasy? I say, it’s about damn time! I say, docs have had to way too good for way too long! It’s about damn time they get off their high horse and come back down to earth with the rest of us common pukes! It’s about damn time the consumer had more say in the healthcare process. That’s what we are beginning to see with the new healthcare reform law. More wellness and good outcomes and less fee-for-service medicine that only works to benefit the provider. Docs don’t like it because the gravy train is beginning to come to an end for them! Docs are going to face much more scrutiny. Docs are going to face much more criticism from the patient. Docs are going to be under a microscope with just about everything they do. They’ve milked the cow for decades and now the cow has run dry. The goose that lays the golden eggs is dead! The game is over! Docs uneasy? Get real!

  2. oncdoc says:

    I work more than and make less than most of my friends from college!
    I don’t mind because I do love what I do. Angry Doctor haters like Paul, however, make me reconsider why I chose Medicine as a proffession

  3. Paul says:

    It wasn’t angry doctor haters that ruined your healthcare industry. It was the greed and corrupt motives that has existed for decades among the providers. Consumers were merely the victims. Had the providers in the industry conducted themselves with due diligence and had they taken their fiduciary responsibilities more seriously, healthcare would not be the broken system that it is today. Idiot doctors here need to face facts, they were the professionals and they didn’t police their own profession. Got that? Our healthcare system is like a kindergarten program run amuck! Now it’s time we bring a few adults into the room and get things under control. That is what Obamacare begins to do. It’s time to elevate the consumer and give them more say in the process. It is time that the customer becomes king, not providers!

  4. nancy says:

    In my opinion, Paul has it right. The healthcare industry has gotten like the used car industry. Most people simply don’t trust them. Once, healthcare was a respected profession. Now, it’s all about “show me the money”! The respect and trust are gone. More tests, more medicines, more hospital admissions, more office visits, more, more, more, more, more!

  5. Well, isn’t it the free market way to make the providers figure out how to improve outcomes and therefore get more money?

    Personally, I think no one should be able to profit from the suffering of others, but I’m a wild-eyed, crazed, hippie-commie-freak.

  6. Chuck says:

    This is what happens when you have leaders in our country pitting Americans against Americans.
    Paul becomes so filled with jealous and hatred that he has lost all trust in the medical system…all docs are greedy…they need to get off their high horse…

    Oncdoc in return feels guys like Paul are just haters and have no clue what it is like to run a medical practice..

    Ultimately oncdoc will say screw it, my doors are closed…Paul will said good who needs the greedy bastards..and in turn who suffers in the end??

    I am not a doctor or a health professional…I do know the doctors I see have spent 12 years of their life in post secondary school and if they hiccup wrong they get sued…

    My doctors are nothing but caring professionals who IMHO are paid too little.

    Our president has done an extremely effective job in turning out angry dudes like Paul and Oncdoc… Fighting each other hating each other…..but dam it’s a great strategy to stay in power…

  7. bMED says:

    These comments display that neither side understands the other. One thing to consider, as Chuck says, these docs spend 12+ years in training, have hundreds of thousands of dollars in school load debt, and have specialized skills required to heal people and keep them alive. To believe that if they make more than $100,000 a year makes them greedy is naive and probably jealousy. I’ve always said, if you like, next time you are sick, perhaps you should visit your mechanic and see if they can make you well. Wait till you get the bill – you’ll see that they actually make more than some doctors!

  8. Sara says:

    Paul needs to seek better understanding of the health care system, as well as clean up his repulsive use of the English language. It isn’t the doctors that turned healthcare into the inefficient system it is today. Ever think about Pharmaceutical and Medical Device companies? The extrodinary prices they charge for their products are passed along to the patients who need/are prescribed them. Ever think of the fact that while physicians are on the front lines treating those who are in need, there are finance, facilities and administrative departments behind them running the business—inefficiently, granted. Thank goodness reform is here so that healthcare As An Industry will improve. And thank goodness for compassionate doctors who continue to practice despite the stress of this industry.

  9. I understand the need to rein in health care costs, and on the surface of it, in the name of the minor god “efficiency,” it is certainly reasonable to ask that physicians be reimbursed according to outcome just as most other job-holders are. I understand Paul’s anger at the medical profession. it is not entirely misplaced. And I agree that to overlook the contribution of the pharmaceutical and medical device industry in breaking our health care system is to miss a big, big piece of the thing.

    Don’t get me wrong. I’m a big, big supporter of the Affordable Care Act. But…

    What I have to wonder is, how is my oncologist to get paid for providing her services to me? Does she get paid more if I become cancer-free after my initial diagnosis and treatment than she would if I do not become cancer-free? Results, after all. Efficient results that will return me to the workforce without cancer.

    Much as I would like that to always be the case, it is not. And it’s not fair to hold her reimbursement for her services hostage to the outcome of my treatment. It’s not like she can control whether or not the cancer responds to the treatments.

    What if I become NED (no evidence of disease) for 3-4-5 years and then have a recurrence? Is she reimbursed less because I recurred….as if she had not done the job right the first time, so I had to come back in, and because of that she will get less?

    And what about the fact that given that I had an aggressive, late-stage cancer, it’s possible that I will indeed recur and then die on her. Does she get penalized because she wasn’t able to treat me effectively enough to make me life and continue my life as a productive worker?

    The fear I have about an exclusively results-based reimbursement scheme is that it will motivate doctors, trying to be “efficient” business people and maximize their company’s profits, to refuse to see patients whose outcomes are less likely to be the positive kind that will up their reimbursement rate. If their reimbursement is to be based on outcomes, what motivation other than simple human compassion will doctors have for taking on high-risk cases where the outcome is, at best, uncertain?

  10. oncdoc says:

    Thank you Brenda and I wish you success in your fight against cancer!

    You mention Drs trying to maximize “their companies profits”. The problem is that 70% of physicians are now employed and are therefore not in control of their business. They are “selected”(hired, promoted and even fired) for their profit potential. Whatever profiteering has occurred over the yrs by physician owned practices is nothing compared to what has happened in for profit health systems since the employment trend really took off. Not for profits are not much better; it’s just the administrators taking the profit. Drs are caught in the middle and if they don’t play the game will be moved out of the way. Employed physicians don’t really work for the patient! People like Paul should understand that complaining about “doctors” ,when 70% work for some big organization, doesn’t make any sense; they should complain about or to the employers.

    Just to be clear; I’m not ripping on employed docs and the way things are going I may be one soon!