The Affordable Care Act (ACA) places primary care physicians (PCPs) front and center in the mission to improve the health of Americans, and lower overall healthcare costs. But new ACA-derived payment models that reward value, not volume, are driving skepticism and uncertainty among physicians. Nine out of 10 physicians cited shifting reimbursement models and the financial management of practices as their top challenges, according to a 2013 Wolters Kluwer Health survey.
In the next two to five years, the shift from fee-for-service (FFS) to value-based reimbursement will be even more dramatic. The trend adds even greater urgency for physicians to better understand payment reform and plan to adapt, says Deborah Walker Keegan, PhD, FACMPE, president of the Asheville, North Carolina-based consulting firm Medical Practice Dimensions, Inc.
“This is really a tough time because physicians still need high productivity, but they also need to start measuring value,” she says. “The levers haven’t really switched from productivity to quality and value, but you don’t want to have a learning curve that is so steep you can’t deal with it when the switch gets flipped.”
Reform, however, doesn’t mean physicians will be paid less, counters Reid Blackwelder, MD, FAAFP, president of the American Academy of Family Physicians. Cost savings to the system from better efficiency and reduced duplication of services should benefit physicians.
“All of the new models, including the ACOs [accountable care organizations], are about sharing risk and sharing savings,” he says. And that can increase payments, especially to PCPs.
Walker Keegan says many private payers are now entering into ACO-like contracts with medical practices based on shared savings models and other payers are paying case rates or a flat fee per patient to help practices develop infrastructure and support for a new system of care delivery. Others are contracting with medical practices for bundled payments or flat rates, betting on care coordination as a cost saving measure.
In many areas, private payers are ahead of the government in implementing value-based pay models, she adds, but Medicare’s value-based modifier for large medical practices treating Medicare patients is scheduled to go into effect in 2015 with full implementation scheduled for 2017.
Our coverage details key trends and considerations related to some of the new payment models, including: