As healthcare reform moves from the planning stages to implementation, Robert Kocher, M.D., former special assistant to President Obama for healthcare and economic policy, sees an opening for the government to better support small, independent practices, per an op-ed in the Wall Street Journal.
The initial round of changes produced by the Affordable Care Act (ACA) have tended to favor consolidated markets, a policy decision Kocher says was predicated on the idea that only large-scale hospitals or health plans would be able to make the technology investments necessary for coordinated care. While he still believes the free flow of information among physicians in a network offers benefits for care coordination, given the combination of quality and savings benefits shown by independent providers, he now suggests too much consolidation is counterproductive.
The policy preference for consolidation appears in the legislation: the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has come under fire for stacking the deck against smaller providers, as FiercePracticeManagement has reported. In an article published in NEJM Catalyst, Kocher and co-author Anuraag Chigurupati, M.S., note that the alternative payment models (APMs) recognized under the ACA “have largely been relegated to the most consolidated health care markets and to organizations managing capitated risk for Medicare Advantage patients.” MACRA’s incentives push doctors to build on this model by offering greater rewards for organizations that adopt it, effectively pushing for further consolidation.
In reality, Kocher says, small practices can deploy technologies that enable them to share data more easily and more quickly than anybody in the government anticipated. He urges the government to consider ways to keep small practices profitable under value-based systems and to de-emphasize the incentives for consolidation. From Kocher’s perspective, this would allow the system to continue to adapt value-based payment models without sacrificing the close personal relationships small-practice doctors have with their patients.
- see the op-ed
- here’s the article