Physicians need support and guidance from the federal government and from payers as they deal with the challenges of transitioning away from fee-for-service, according to a report released Thursday.
The RAND Corp. and the American Medical Association did case studies on 34 physician practices throughout the country between February 2014 and March 2015 to determine the impact of different payment models such as episode-based and bundled payments, as well as shared savings, pay-for-performance and capitation.
While more physician practices are moving toward such fee-for-service alternatives, many surveyed reported difficulties making the capital investments in data infrastructure needed to handle the administrative burden such transitions have created. Also, many practices reported challenges in effectively negotiating with health plans in other payment types.
Many physician practices have responded by developing affiliations or merging with other practices or getting acquired by hospitals, the study found.
“We found that changing the payment system probably isn't enough to ensure that patient care will improve,” said study lead author Dr. Mark Friedberg, a senior natural scientist at RAND. “For alternative payment methods to work best, medical practices also need support and guidance. It's the support that accompanies a new payment model, plus how well the model aligns with all of a practice's other incentives, that could determine whether it succeeds.”
The effect alternative payment models had on practice stability, as well as its financial impact, ranged from neutral to positive, the study found. None of the practices included in the analysis experienced financial hardship as a result of involvement in new payment models.
Most physicians reported the transition to alternative payment models helped incentivize many to look into forming more collaboration with other providers to address conditions affecting their patient populations. Doctors also reported turning to telehealth and community-based care to increase access to patients.
Despite an increase in the use of such alternatives, the study found that efforts to improve efficiency by some physicians by delegating some tasks to non-physicians ended up making doctors even busier, raising concerns over burnout.
The study's findings come as many providers prepare for a seismic shift in the way in which Medicare reimburses for services. In January HHS announced a goal of tying 30% of Medicare payments to a value-based alternative model such as bundled payments by the end of 2016, increasing to half by the end of 2018.
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