Obamacare receives a big, fat 'F' from physicians
“There’s so much reporting, data collection, number crunching, documentation, interaction with patients designed to capture numeric information and metric information, and the typical independent physician who might be in a private practice increasingly doesn’t have the scale, infrastructure or capacity to be able to meet those requirements,” Northeastern’s Hoff says.
Additionally, how can value be measured when patients become healthy and no longer require medical services? “This creates a lot of challenges for hospital executives who still need to fill their beds to some degree and have substantial numbers of employees,” Young says.
ACOs are a value-based model, consolidating care and reducing duplicate services by sharing risks and savings. But working under a model that rewards results has its own stresses. In fact, a 2013 survey by Wolters Kluwer Health found that managing shifting payer reimbursement models is the most pressing business challenge among physicians.
Moreover, a 2015 study by Rand Corporation sponsored by the American Medical Association found that “financial incentives applied to physician practices via alternative payment models were not simply ‘passed through’ to individual physicians.”
Independent practitioners are also increasingly partnering with other caregivers under a bundled payment system. With bundled payments, healthcare providers share a single payment for a range of services instead of each provider billing separately. This benefits the patient, because she can see what, exactly, she is paying for among a comprehensive set of services—and payers and providers share risk.
“If we look at it as a product and figure out a way to reduce all the different cost components and we have motivation to make money by getting the patient out quicker and healthier, and if we all come together as a team, won’t it be better for the consumer to look at a single price for the whole thing?” attorney Rust asks.
Under this system, however, there is a concern that physicians may lose some clinical autonomy when hospitals are in charge of bundling. Someone has to make decisions when it comes to determining how cases are managed and who is paid what, Rust says, and that’s often the person at the top—the hospital CEO. “That’s the vertical line, the consolidation of the industry,” he says.
One reason the data is slow to be added may be the way that physicians are sending their information to CMS. Some medical groups are using a clearinghouse or intermediary, third party to get it to the government, according to Joel Shalowitz, MD, MBA, FACP, professor of preventive medicine at Northwestern University’s Feinberg School of Medicine in Chicago, Illinois. “Sometimes those companies aren’t doing their jobs, so it’s delayed.”