Survey: Hospital, health system leaders slow to adopt risk-based payment arrangements

stethoscope, coins and calculator
A survey of hospital and health system leaders found that a majority have few patients in risk-based payment arrangements. (Getty/mckare)

Hospital and health system executives and leaders said in a recent survey there has been slow uptake of risk-based payment arrangements, with most leaders reporting that less than 20% of their patient population was in such a model.

The survey released Tuesday from major healthcare group purchasing organization Premier found that Medicare remains the primary driver for adoption of risk-based payments. The Trump administration has been trying to spur greater adoption of programs that provide Medicare reimbursements to healthcare facilities based on the value of care they provide rather than the traditional fee-for-service model.

“Results from the survey illustrate how the transition to risk-based contracting has been slow and market-dependent,” Premier said in a release on the survey of 177 hospital and health system leaders. “Less than 20 percent of respondents reported having more than half of their population covered by Medicare fee-for-service risk-based arrangements.”

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Premier found that 64% of respondents reported that less than 20% of their patient population was in a risk-based program. Respondents also don’t think things are going to get much better: only 5% believe they will have more than 80% of their patient population in a risk-based program over the next five years.

The two major barriers leaders cite with implementing risk-based arrangements are a lack of reimbursement adequacy from the federal government and access to timely data. Another major problem is the data that respondents get from commercial insurance payers.

“Ninety-six percent of those surveyed reported that the data they receive from commercial payers is inaccurate or not standardized, or both, if they receive it at all,” Premier said.

Responses also called for major changes to legislation and regulations to spur the adoption of more risk-based systems, including offering providers more flexibility as they take on more risk.

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A popular request was to relax provisions in the 1989 Stark law, which prohibits doctors from referring Medicare and Medicaid patients to healthcare entities the doctor has financial ties to. Many in the healthcare industry have said the law prohibits doctors from entering into a risk-based payment arrangement with other health facilities.

Centers for Medicare & Medicaid Services Administrator Seema Verma has said the agency plans to release a Stark overhaul this year. CMS has widely embraced value-based care. Just this year the agency has released new payment models for primary care, dialysis and radiation therapy.

But some say that the agency still needs to do more in clarifying the best way for healthcare systems to enter into risk-based arrangements.  

“There is a great deal of uncertainty as we explore moving to risk-based contracts,” said Steve Neorr, senior vice president and chief administrative officer of the physician-led accountable care organization Triad HealthCare Network based in North Carolina. “We call on the Administration to provide more details on the emerging alternative payment models to help inform the best path forward for our system.”