Only one in three family physicians is working toward value-based payment opportunities, but according to the American Academy of Family Physicians, that seemingly low number is actually encouraging.
Another 19% are developing value-based payment capabilities, but holding back until results of the new payment model are better documented.
That might prompt the question, why are only 33% actively pursing this new payment modality? However, to Wanda Filer, MD, MBA, president of the AAFP, the one-in-three survey result is a pleasant surprise.
“I think there’s still a lack of clarity around what the term value-based payment means,” Filer says. “So, I was pleased to see that these numbers are as high as they are this early in the transformation process.”
Glass Is One-Third Full
Filer says the survey’s positive results stem from the increased conversation taking place in the industry, as well as press coverage in medical literature detailing the ups and downs of these models. As such, physicians are taking a greater interest in learning about ACO models.
“We, as an academy, have been communicating to them that value-based payment is really the wave of the future,” Filer says. “And they need to do the practice transformation ahead of the curve.”
Filer explains that over the past five years a significant percentage of AAFP members have certified as patient-centered medical homes, which puts them in a more favorable position for the transition to value-based payments.
But that doesn’t mean there isn’t a great deal of work still needing to be completed.
“I also think it’s an issue of educating the physician, the practice managers, all of the people who make those determinations,” Filer says. “It’s also an on-going effort to help those practices continue that transformation into medical home, and to sustain those that have already done it, because it’s not inexpensive. It’s also very time-consuming.”
Time and Money
According to physicians surveyed, time seems to be the biggest barrier to even considering a transition to value-based programs, followed closely by the cost factor. More than 90% of physicians surveyed noted a lack of staff time as a barrier to implementing value-based care delivery, and 87% indicated they will have to make substantial financial investments in health information technology in order to have success.
Are those factors real, or perception?
“Trying to find time to do this is a very real issue,” Filer says. “One of the things we’re hearing is that because of these clunky electronic health records, physicians are trying to see patients all day and then have something we call WAC, work after clinic, and that is frequently having them up finishing notes until midnight.”
Cost is another real issue, Filer says. She recalls a recent conversation where a vendor told a physician that they would be happy to update his electronic health record so that it worked with a specific registry—which is going to be needed in a value-based payment system—but that it would cost $25,000.
“Family medicine, in particular primary care, has been under-compensated, under-paid, and under-appreciated for a very long time,” Filer says. “Many of these practices are on extremely tight margins. So anything that is a $25,000 charge is a non-starter.”
Filer’s hope is that many payers will recognize that it’s in their best interests to assist practices in finding a way to get this electronic health transformation done, and figure out if there’s a way that they can help mitigate the cost to the practices.
“Because I think it’s going to be a win-win-win,” she says. “It’s going to be a win for the patient in terms of improved quality of care and coordination; it’s going to be a win for the payer in terms of a decrease in unnecessary testing, and potentially decreased costs because of better quality; and a better payment for the practice, and the physician who can feel more satisfied that they’re doing the quality job they want to do.”
Filer encourages practices to stay ahead of the transformation curve, but is also extremely sensitive to the more than 90% of physicians surveyed for whom time is an issue.
“Look at the AAFP website, and also reach out to your state chapter,” she says. “Most of our state chapters have immense resources at no cost, on our websites, to help you look at an analysis of where you are now, and what kinds of things you might need to incorporate. And many practices are further along than they think. Even having an electronic health record is one major step.”