If you're not already trying to navigate bundled payments, pay-for-performance, withholds and risk pools, capitation and shared savings, you will be soon. Although many doctors still receive payments on a fee-for-service basis, there's no avoiding these radically different payment models. With an emphasis on lowering cost and improving quality, more doctors are being put on a budget and required to do a better job coordinating patients' care.
To help physicians understand the new reimbursement issues before them, the American Medical Association on Friday released a new how-to manual for evaluating and negotiating emerging payment options. Topics covered within the 119-page document include establishing baseline costs, shared savings proposals and ethical considerations in managed care contracts, among other guidelines.
Demand is high for expertise regarding many of these new models, especially ACOs. A recent article in Medscape Today addresses several of physicians' big questions about how ACO participants will be paid and share in any savings achieved (both generally determined by the group practice or governing body of the ACO).
According to a recent paper on physician payment reform published by the Massachusetts Medical Society, most providers in the state favor fee-for-service reimbursement because it pays them for "what they do," but they recognize its inherent limitations.
The surveyed physicians expressed difificulties with new payment models so far, including frustration that different payers use different metrics in pay-for-performance, high administrative overhead and complexity in adopting new models and concern that implementing new programs may take attention away from patient care and other activities. "Most remain hopeful, however, that some of the newer models will provide better reimbursement for the care they know is needed in order to improve the care of the public," the authors from Tufts University School of Medicine wrote.
To learn more:
- read the statement from the American Medical Association
- download the AMA's how-to manual
- see the article from Medscape Today (registration required)
- check out research (.pdf) published by the Massachusetts Medical Society