Payment reform pushes providers to keep financial tabs on patients

When it comes to payment reform, Massachusetts is at the forefront. A recent article in the Los Angeles Times offers the rest of the nation a glimpse of what it's like for physicians delivering care under a new set of rules.

For starters, patients who receive primary care from Damian Folch, a general practitioner in Chelmsford, Mass., get a lot of attention. With the practice financially responsible for how patients fare, any test result, missed appointment or need to get a test triggers a call or email.

"We are a real pain in their necks," Folch told the newspaper. "We track them down."

In addition to keeping better tabs on patients and the technology required to do so, Folch said it's been a challenge to steer patients toward less-expensive settings for services, such imaging tests or eye exams.

"I try to explain that I'm not throwing them to the lions. I am referring them to people that I go to," Folch said.

At the end of the day, however, data shows Massachusetts patients are getting healthier. Last year, for example, all of Folch's diabetic patients successfully managed their cholesterol and had their yearly diabetic eye exams.

Although the goal of models, such as global payment programs, is to reward doctors to control costs by improving quality, so far, Massachusetts continues to have the nation's highest medical costs, spending nearly 50 percent more per person than the national average. However, early research in the Commonwealth suggests it will save costs in the long run, according to the newspaper.

Nonetheless, many prominent experts say that payment reform is an indispensable aspect of reforming the nation's healthcare system in general. In a recent post for, Timothy Johnson, former medical editor for ABC News, wrote, "No matter what form or structure healthcare takes, without payment reform, it will be doomed to failure." He added, "There are many 'outcomes' payment ideas--bundling, global, etc.--but they are all designed, in theory, to force providers to live within a certain budget for a given patient. Obviously, this is a huge culture change and will require many years--and many mistakes--to figure out."

To learn more:
- read the article from the Los Angeles Times
- see the post from