Berkeley, Calif.-based Alta Bates Medical Group as of July 1 will reimburse its 250 primary-care physicians on a fee-for-service basis, ending four-and-a-half years of capitated payments. Alta Bates, whose 130,000 covered lives make it California's fifth-largest independent practice association, was one of the first IPAs to convert its primary-care doctors to capitation from fee-for-service.
Alta Bates executive director Lori Hack says the move back to the future is being motivated by employers, who are looking not only at cost but also at quality and access to care as important factors in choosing a physician organization.
Because of those factors, Alta Bates' second shot at fee-for-service won't look quite like its first. Doctors' pay will include a 5% to 10% percent bonus, paid at least quarterly, based on patient satisfaction, willingness to take on new patients and other noneconomic measurements.
Also, doctors still will have a limited pool of dollars to divide amongst themselves, although it won't be divided on a per-patient basis as in capitation.
"It'll be paying out the same amount as before, but to different people," Hack says.
Given that, as Hack says, "the physicians all believe they are practicing the same level of quality and service," putting in such a pay system has some doctors nervous. Hack said none has yet threatened to drop out of the IPA, but once Alta Bates sends out its final reimbursement plan, she suspects "that'll come."
Alta Bates' 500 specialists will remain under capitation. However, they are expected to end up seeing fewer patients as a result of the changes wrought on their primary-care colleagues.
The plan will help differentiate the IPA in a market where employers are beginning to demand documentation of quality as well as low cost. The IPA will help ease the change by installing electronic claims systems in physician offices throughout Contra Costa and Alameda counties.