Hospitals and physician practices have begun implementing new value-based models of reimbursement as mechanisms to increase physician engagement in healthcare reform and care quality, but there is currently limited participation in these new models, according to a study recently published in the American Journal of Managed Care.
To explore different physician perceptions about the mandates of the Patient Protection and Affordable Care Act as it relates to the triple aim — increased value and quality at lower costs — the study synthesized insights from three quantitative and qualitative datasets between 2011 and 2014.
Analysis of these datasets found that physician engagement in healthcare is generally incentivized by pay-for-performance models and metrics, and there is currently little evidence to show hospitals have plans to sustain physician engagement other than performance incentives, according to the report.
The following five points represent key areas for improvement between surveyed physicians and the adoption of the new healthcare delivery model to accomplish the triple aim, according to the study.
1. Exhaustion resulting from change. Qualitative analysis showed physicians have experienced significant fatigue from the changes linked to the PPACA and especially by the demands of new reporting regulations and performance metrics.
2. Complicated policies. Already highly impacted by policy, the implementation of the PPACA has significantly increased the number and complexity of healthcare policies. According to the study, qualitative analysis indicates these new and shifting policies create frustration and confusion for physicians.
3. Uncertain direction of success. According to the study, many physicians are receiving mixed messages on how to succeed under new metrics. Approximately 59 percent of employed providers who responded to Medscape online surveys (one dataset included in the quantitative analysis) reported they are still held to volume targets. Many physicians find the persistence of these targets to conflict with value-based care models.
4. Wary of "cookbook" medicine. Many physicians are concerned that evidence-based medicine can be reduced to tactless "cookbook" medicine, according to the report. Physicians have expressed cautionary opinions of evidence-based medicine, especially that guidelines are being implemented as hard rules that limit physicians' ability to recognize and care for individual patient needs.
5. Primary care physician compensation is lagging. Despite the importance of PCPs in the performance of value-based models, their overall compensation is significantly lower than that of other specialties. According to the study, trends in physician compensation place PCPs in the bottom quartile for the past four years.