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VBCR - December 2015, Volume 4, No 6 - Value Propositions

As the healthcare system in the United States moves slowly toward a value-based strategy, a recent online article noted that value-based care can lower costs and is certainly beneficial for insurers, including Medicare, but asked, “...does it bring benefits to physicians or patients?” Answers to that question varied for large and small practices, physicians employed by hospitals, and specialists, and were influenced by other payment systems in use, such as pay for performance, bundled payments, and participation in accountable care organizations (ACOs).

Most physicians currently practice on a fee-for-service model, and the transition to value-based payments will take time and effort. James Holly, MD, is CEO of Southeast Texas Medical Associates, a multispecialty practice with 50 providers in Beaumont. He reports using value-based approaches for almost 20 years and advises practitioners to speed up the shift. But this group employs 6 people to manage its information technology (IT) system, which was built over the past 18 years at a cost of more than $9.5 million.

Although some physicians have begun to receive income from value-based programs, Elizabeth Woodcock, a practice management consultant in Atlanta, GA, reports that value-based payments might account for 1% to 3% of income in an average practice—an amount that may not cover the costs of the personnel, equipment, and data processing needed to qualify for the programs. Doctors, especially those with small practices, often need help with creating IT systems, and companies are being established to help meet these needs.

Primary care physicians (PCPs) are the current focus of value-based programs, and specialists are not expected to be rewarded by ACOs. When offering referrals, however, some PCPs may look for specialists with high value-based scores, and specialists with low scores may be barred from participation in some narrow networks.

Page L. Medscape website. October 8, 2015.

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Last modified: January 13, 2016
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