Physicians are increasingly being held responsible for costs of care in addition to quality care. The shift will change the way physicians do their work.
Accountability, defined as “the obligation or willingness to accept responsibility” for one’s actions, is something physicians urge their patients to do when it comes to their own healthcare.
Now, physicians are being asked to do the same—but where healthcare costs are concerned.
According to a joint survey by the American Association of Physician Leadership and the Navigant Center for Healthcare Research and Policy Analysis, 69% of physician leaders say doctors should be held accountable for costs of care, in addition to quality of care.
The survey is the first of a three-part research series focused on physicians’ attitudes toward healthcare reform and the move from fee-for-service to value-based care delivery and payment models.
It’s one thing to say someone or a group of individuals are accountable for a particular achievement or outcome, but defining what accountability is, that’s a different story. And according to Paul Keckley, PhD, managing director of the Navigant research center, it’s a loaded term.
“Physicians want to be accountable for the elements of care that they can control,” Keckley says. “But what frustrates physicians is where they’re held accountable for things out of their control.”
Keckley explains that when it comes to advising patients not to smoke, or about making lifestyle changes, physicians are ready to accept that accountability. Where it becomes challenging, however, is if they’re held accountable for whether the patient actually stops smoking, or actually takes their medications.
“Measurement of that (accountability) is something that is a work in progress.”
Peter Angood, MD, FACS, FRCS(C), MCCM, president and CEO of the American Association of Physician Leadership, agrees. He explains that while reporting strategies surrounding cost and quality of care continue to gain momentum, the measurement science surrounding those strategies is relatively immature.
“Physicians feel, in their altruistic way, that they should be accountable for patient care,” Angood says. “But they do get frustrated, as Paul says, by the systems and processes, which sometimes go against trying to give the best of care.”
Change Presents Challenges
Among the survey results, 57% of respondents agree or strongly agree that accountable care organizations will be a permanent model for risk sharing with payers in the years ahead. Keckley believes these results, and others, demonstrate an important shift among physician leaders in recognizing the changes taking place in the healthcare market.
However, those changes won’t be without their share of challenges.
“There are some markets where the chief medical officer is going to have to do a lot of heavy lifting to get rank and file physicians to accept that the world has changed,” he says. “There’s a big difference between a traditional academic medical center where you have a department or a faculty structure, and a community where you’ve got independent doctors practicing in single specialty groups. I think the biggest challenge the chief medical officer sees in this transition is how to change the behaviors of rank and file physicians.”
Angood believes there are bigger and broader questions that need to be answered. He points out that the patient population as a whole holds a very high trust factor toward physicians, and expects them to be leaders in their society—regardless of whether or not they have a formal title in running a large healthcare enterprise.
“At some level, all physicians are leaders,” Angood says. “And so, how do we help the physician workforce continue to embrace that expectation that society has of them? And how do we help that physician workforce continue to have pride in their profession and to really show and demonstrate different levels and different types of leadership, informally as well as formally within their community?”
More Questions to Answer
Angood believes that the insights from the survey will guide the mission of providing physicians leaders with the key competencies and skills necessary to deliver the highest quality of care to their patients.
“It’s not enough just to have an MD behind your name,” he says. “The importance of this survey is that when you look critically in the literature, there’s not a lot of data yet as to how do we quantify and qualitatively describe the benefit and the value of physician leadership. So this survey work is our beginning of building the base of some of that information so that we can better design future research studies and focus on which of the competencies are critically important.”