Physicians frustrated by complexity and speed of alternative payment models, report says

As payment reform slowly takes hold of the healthcare industry, physicians are clamoring for more clarity around new payment models, according to a new report from the American Medical Association (AMA) and the RAND Corporation.

According to physicians and practice leaders interviewed for the study, alternative payment models (APMs) are evolving too quickly. Interviewees also said APMs are increasing in complexity and becoming more burdensome.

“We need to call a timeout,” one physician who owns an independent primary care practice told researchers pointing to the revolving door of programs like MACRA, Meaningful Use and more.

“We don’t even have time to take a deep breath in order to digest what is important."

These frustrations were especially prominent among smaller practices, the report said. Larger practices (and physician groups) were able to invest more time and resources into preparing doctors for regulatory changes.

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Larger practices can also provide their doctors a buffer from financial incentives and shield them from burdensome tasks by shifting them to other employees, like having scribes enter EHR data.

Don Blanchon, CEO of Whitman Walker Health, a federally qualified health center in Washington, D.C., reiterated this sentiment at a panel on Wednesday discussing the findings. Smaller providers like his have less money to spend on the things necessary to receive bonuses, he said.

At the same time, he explained, APMs don’t incentivize providers for services like home visits and behavioral health, important services that can benefit many patients.

Under the current regulatory structure, the government pays physicians employed at hospitals twice as much as it pays physicians in private practice, said Justin Cohen, M.D., a urologist and the chief compliance officer at UroPartners LLC, which serves the Chicago area.

Private practices can be more nimble and, as a result, decrease costs and improve quality, but they are often under-resourced, he added.

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An audit conducted by the federal government earlier this year also found small practices struggle to succeed in value-based incentive programs.

The AMA-Rand report also found reluctance among providers to take on downside risk—a sentiment that, again, conflicts with CMS’s goal to increase accountability among providers.

“A physician should never ever ever compromise the quality of care because they’re taking on downside risk,” said Cohen, who prefaced his statement saying he rarely uses absolutes. “We’re starting to be put in a bad situation where that might come to pass.”

The AMA-RAND report recommended simplifying APMs so practices can focus on improving patient care, as well as a “stable, predictable, moderately paced pathway” for these models. Federal agencies should also avoid forcing practices to take on two-sided risk while helping them secure the skills, experience, and resources to succeed in these payment models.