Report: Culture change must precede ACO, medical home success

Physician practices, especially in primary care, have experienced myriad changes in recent years driven by the Affordable Care Act (ACA) and other trends. Although the long-term impacts of emerging delivery and reimbursement models remain to be seen, a new survey from The Commonwealth Fund and The Kaiser Family Foundation shows a mixed bag of primary care physician (PCP) reactions to transformation.

"The Commonwealth Fund/Kaiser Family Foundation 2015 National Survey of Primary Care Providers" is derived from a nationally representative sample of 1,624 primary care physicians and a separate sample of 525 nonphysician providers such as nurse practitioners (NP) and physician assistants (PA). Key findings of the report include the following:

  • About one-third (34 percent) of PCPs surveyed said they are still paid on an exclusively fee-for-service basis, while 64 percent said they are paid by capitation, salary or a combination thereof.
  • Twenty-nine percent of all PCPs said they participate in an ACO arrangement with Medicare or private insurers, while 34 percent of those who accept Medicare said they participate.
  • Among the 29 percent of respondents currently participating in an accountable care organization (ACO), 30 percent said ACOs are having a positive impact, 25 percent said their impact is negative, 20 percent said they have no impact and 25 percent were unsure.
  • Meanwhile, about 30 percent of PCPs reported receiving incentives or payments for qualifying as a patient-centered medical home (PCMH) or through the ACA's Advanced Primary Care Practice (APCP) medical home demonstration. Practices receiving incentive payments to become medical homes were more favorable to the model.
  • Overall, 41 percent of PCPs said that the industry shift toward team-based care is negatively affecting providers' ability to provide quality care, but physicians who had NPs or PAs on staff were more favorable to the trend. 
  • Half of physicians (50 percent) and nearly four of 10 nonphysician practitioners (38 percent) stated that the increased use of quality metrics to assess provider performance is having a negative impact on quality of care. 

It may be too early to truly assess the effectiveness of these changes, the report authors wrote, nonetheless adding that understanding the experience of those on the front lines is critical to overcoming implementation challenges of such reforms.

"Dissatisfaction with new models may not be solely attributable to a difficult transformation process; larger culture change within the practice of medicine may be a necessary first step before delivery system reforms such as ACOs and medical homes are fully accepted on the ground," the authors concluded.

To learn more:
- read the report