The Affordable Care Act and the move from volume-based to value-based care was supposed to transform how the industry paid providers. But little has changed, according to a new study in the Annals of Family Medicine,
Bundled or incentive payments make up only a portion of a large mosaic of how doctors are paid, according to the study. Researchers surveyed 632 different medical practices--both affiliated with accountable care organizations and not--found that physicians were paid with salaries, fee-for-service based on quality scores and other metrics.
Altogether, the ACO and non-ACO practice doctors received about half of their compensation in salary and a slightly smaller amount based on their productivity--which may not have a bearing on the quality of care being delivered. Only about 5 percent of total pay was linked to quality measures.
"Incentives for ACOs may not be sufficiently strong to encourage practices to change physician compensation policies for better patient experience, improved population health and lower per capita costs," the study concluded.
There has been reticence in including individual phyisicians directly into payment reform, particularly since it has raised concerns about such payments encroaching on their clinical autonomy.
"I think it points to a potential problem: that these incentives aren't getting translated to individual physicians," Andrew Ryan, a University of Michigan School of Public Health economist and study lead author, told the Washington Post.
However, the iindustry expects that the repeal of the Sustainable Growth Rate payment formula for physicians will be replaced with a system that provides more incentives for improving the quality of care.