Increases in value-based payment adoption decreased family physician burnout, AAFP study finds

Family physicians utilizing value-based payment (VBP) models reported burnout relief in a new study from EHR company Elation Health and the American Academy of Family Physicians (AAFP).

The study found that burnout among providers decreased once practices passed a threshold of 75% financial investment in VBP models. The second collaborative study between Elation and AAFP’s Innovation Lab surveyed 10 practices to pinpoint the hurdles in VBP adoption. Economies of scale in larger practices and those with network affiliations increased manageability of VBP administration. For those who had adopted VBP arrangements but not reached the 75% mark, burnout was shown to increase, according to the study.

This indicates that payment models likely have a significant impact on physician burnout, the study authors said.

“We were really able to spend some time talking with these physicians to find out what their experience has been like,” Sara Pastoor, M.D., Elation Health senior director of primary care advancement, told Fierce Healthcare. “There are a handful that are really happy and thriving, but, for the most part, many are still in the struggle of reaching full VBP adoption. We urgently need to find ways to help them.”

Participating practices varied from solo physicians to larger practices of 25 to 50 clinicians to one corporate VBP organization. Elation and AAFP previously collaborated on a study measuring burnout rates in family physician practices. 

The study found that higher capitation rates combined with greater overall percentage of revenue from capitation most effectively relieved physician burnout, mirroring results from previous studies that also determined a VBP adoption tipping point. 

Increases in burnout were revealed once practices reached 59% adoption but not yet 75%, Pastoor said, as practices at that level of adoption still had “one foot on each side of the fence.” Practices with lower staff-to-physician ratios also reported higher burnout rates. 

The previous collaborative report conducted by Elation and AAFP found that support staff was a key component in predicting physician burnout. The report also indicated that half of family physicians reported stress and burnout. 

Prospective payments as opposed to “bonus payments” were highlighted as an important tool for exiting the “fee-for-service hamster wheel.” This way, practices could budget for the investment in long-term assets like new staff, further decreasing administrative burden, and new equipment, according to the organizations. 

Based on the study results, Pastoor said the easiest and quickest way for smaller practices to reach full adoption is through joining collaborative networks to gain access to economies of scale. “That opens them up to take advantage of shared savings, which is where the real money is,” she said. Without entering a larger system, small independent practices find themselves trapped between two administrative structures while negotiating both.  

“I’ve sometimes heard it referred to as operating a vegan steakhouse,” Pastoor said. “It’s two completely different business models. The administrative requirements and the operational requirements to deliver care under fee-for-service are so dramatically different than under value-based payment. So you end up having to do both for a while, and you can’t really realize the benefits of value-based payment.”

In addition to accessing shared savings, joining collaborative groups allows small practices to offload downside risk onto federating bodies while increasing access to upside risk, according to Pastoor. 

As adoption of VBP trickles through family practices, Pastoor sees the industry in a state of experimentation. Many practices reported mixing and matching payment arrangements. Furthermore, the study found that financial feasibility of VBP oftentimes was dependent upon the quality of the contract. 

“We talked to one practice that had more than 50% capitated but the capitation rate was only $28 per member per month,” Pastoor said. “That’s just not enough money to give you the extra revenue that you need to invest in the things that will help you be successful. A lot of it boils down to the quality of the contract, and the number of payers can increase the complexity, so that adds to the administrative burden.”

Despite the challenges in implementing VBP in a successful manner, Pastoor doesn’t see anyone interested in going back to fee-for-service. What she has seen is family physicians abandoning their practice model altogether and moving to hospice care or direct primary care. 

AAFP represents 127,600 physicians and medical students across the country, making it the largest medical society focused exclusively on primary care. According to the organization, family physicians conduct roughly 1 in 5 office visits and provide more care for the underserved and rural populations than any other medical specialty. 

Elation provides technology solutions utilized by 30,000 clinicians treating over 3 million patients. The company completed a series D funding round of $50 million in 2022.