As the nation prepares to put a new tenant in the White House, healthcare experts are signaling that they favor an overhaul in the way healthcare providers are paid.
Some 69% of healthcare experts say the current fee-for-service payment system does not encourage high-quality and efficient care, and 85% say fundamental change to the provider payment system, with broad incentives for quality and efficiency added, would improve it.
The results are from the latest Commonwealth Fund/Modern Healthcare Opinion Leaders Survey, conducted by Harris Interactive between mid-September and mid-October. Some 222 healthcare experts with backgrounds in academia, health policy, healthcare delivery, finance and business responded to the online questions, which focused on healthcare delivery reform.
The results suggest that healthcare experts believe small-scale demonstration projects and tweaking of the current system are not enough to fix the inefficiencies of the fee-for-service model, says Commonwealth Fund President Karen Davis. Many of the opinion leaders support a payment system that holds providers accountable for the whole cost of a disease treatmentnot just one visit. Thats a big shift, but its one that these types of economic and financial times suggest we need to move forward with, Davis says.
Sharon Arnold, vice president of AcademyHealth, a not-for-profit organization in Washington that represents health-services researchers, says that payment is not necessarily the best vehicle to encourage high-quality and efficient care, but that it should not stand in the way of achieving those objectives either.
The payment system is basically visit-based, and so payment occurs when the patient comes into your office and you do a visit, says Arnold, a survey respondent. I would like to see a system that combines some sort of aggregated payment, whether a capitated payment or episodic payment, with additional payments for specific services provided.
Other healthcare leaders who answered the survey questions seem to agree. More than half of respondents say they would prefer moving to a system that would blend fee-for-service payment with a bundled paymenta single payment for all services provided to a patient during a year. Only 1% say they prefer the current payment system, while 23% say they would prefer a bundled per-patient payment system with bonuses for high quality, and 9% say they prefer a modified fee-for-service system with bonuses for high quality and efficiency.
Davis says she was surprised at the level of support for such large-scale change and the nearly universal dissatisfaction with the status quo. The fee-for-service system has been around since the start of insurance coverage in the 1930s, she says. Thats quite remarkable, the degree of support for moving away from fee-for-service to more of a bundled payment system.