Just because a new payment model for doctors is different doesn’t mean it will be better.
While the Medicare Access and CHIP Reauthorization Act (MACRA) encourages the development of new physician-focused alternative payment models (APMs), how can the government ensure those new models result in better care and lower spending and help physician practices?
In a study in the American Journal of Accountable Care, researchers outlined some principles to successfully design APMs based on past and present payment reforms. Here are three of their suggestions:
Provide resources to deliver higher-value care. A major weakness in the current fee-for-service systems is lack of payment for many high-value services that could address patient needs at lower costs, they said. For instance, payers should support resources such as patient education and self-management support that could help patients with chronic conditions and avoid hospitalizations.
Hold physicians accountable only for the aspects of cost and quality they can control. A successful APM will hold physicians accountable for factors they can control, (such as how many tests they order, which procedures they perform, how well they prevent avoidable complications), but not for the factors they cannot control (such as the services ordered by other physicians for different health problems or increases in the prices of drugs they prescribe).
Minimize administrative burden. The complexity of current payment models and the systems to administer them have significantly increased costs of healthcare without improvements in outcomes, they said. APMs should not include administrative requirements unless the benefits exceed the costs.