Most docs disagree with doing away with fee-for service, survey shows

Doctors asked to assess options for reducing healthcare costs were not exactly enthusiastic about replacing the system that pays them based on the volume of tests, exams and procedures they perform.

Granted, cuts to Medicare physician pay proved even less popular among the nearly 3,000 doctors surveyed on their opinions for strategies to blunt the nation's high and rising healthcare costs. Just 1% of the polled physicians described their attitude toward this option as “very enthusiastic.”

The survey results were published in the Journal of the American Medical Association.

Just 7% held a similar opinion of a proposal to do away with fee-for-service, or the payment of doctors, hospitals and other healthcare providers based on the volume of their services. Their objections are at odds with policymakers, who often cite fee-for-service as a significant culprit behind rising premiums and public spending for healthcare.

Doctors also showed little love for one popular proposed alternative to fee-for-service, described as “paying a network of practice a fixed, bundled price for managing all care for a defined population,” or capitation. Six percent of physicians said they were very enthusiastic about such an arrangement.

Doctors were more quick to embrace efforts to promote continuity of care and chronic disease-care coordination (75% and 69%, respectively, were very enthusiastic.) Efforts to tackle fraud and abuse also ranked highly (70%).

Physicians were nearly evenly split on their enthusiasm for efforts to reduce healthcare costs that would limit access to costly care with limited benefits (51% were very enthusiastic); compare competing treatments (50%); and the use of cost-effectiveness to decide treatment (47%).

Half the physicians rejected (“strongly disagreed”) the statement that healthcare prices matter only when patients must pay the bill themselves. One-quarter said they were aware of their recommended treatment costs (24% “strongly agreed” with that statement.)

Although 42% agreed strongly with the statement that doctors could be more prominent in efforts to reduce unnecessary medical tests, most of the surveyed physicians said other participants in the healthcare business are more to blame.

Roughly one out of three (36%) said doctors have a major responsibility to reduce cost. That's compared with 60% that said trial lawyers have a major role. Other culprits included health insurers (cited by 59%), hospitals and health systems (56%) and pharmaceutical and medical devicemakers (56%).

Follow Melanie Evans on Twitter: @MHmevans