The nationwide drive toward value-based care delivery aims to keep patients healthier, minimize unnecessary medical services and reduce overall healthcare costs. However, significant barriers persist, according to the American Medical Association.
Two obstacles in current payment systems are preventing physicians from implementing the changes necessary to support value-based care models.
1. Inadequate payment for high-value services. According to the AMA, Medicare and the majority of commercial health plans do not reimburse physicians for numerous services that would benefit patients' health and curb unnecessary spending, such as:
- Responding to a patient's phone call about a symptom or problem
- Communications between primary care physicians and specialists to coordinate care
- Communications between community physicians and emergency physicians, as well as short-term discharge planning in emergency departments
- Investing time in a shared decision-making process with patients and family members when multiple treatment options for a condition exist
- Hiring nurses and other staff to provide education and self-management support to patients and family members
- Providing palliative care along with treatment
2. Financial penalties for delivering fewer services. Under the fee-for-service reimbursement model, physician practices can lose revenue if physicians perform fewer procedures or lower-cost services. At the same time, the costs of maintaining the practice remain the same, which can lead to operating losses. "For many patient conditions, most of the savings payers would experience from new models do not come from the payments that are made to the physician practice, so savings still can be achieved without financially penalizing the physician practice," according to the AMA.
What physicians are doing to overcome these barriers
- More than 100 state and specialty medical associations have joined the AMA in sending a letter to CMS recommending 10 principles to guide the implementation of alternate payment models, which highlight several important goals:
- Provide physicians with greater resources and flexibility to deliver care
- Improve financial viability in physician practices
- Minimize administrative burdens that consume much of physicians' time
- Enable physicians to control aspects of spending that they can influence
- Avoid transferring inappropriate financial risk to physicians