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Ask physicians what they think about valued-based care

Regulatory Burden Survey

Medical Group Management Association, October 2018

The federal government has focused on decreasing the regulatory burden on medical group practices. MGMA has long been a champion for decreased regulatory burden and increased administrative simplification and standardization in order to achieve a more efficient and effective care delivery process for patients and providers.

This study is the second in a series to assess the burden level of regulatory processes for physician practices participating in Medicare programs.

The move toward value

How do you view the move to paying physicians based on value of care delivered rather than volume of services provided?

57% - Negative
38% - Positive
5% - No opinion

Has the move toward value-based payment (in Medicare/Medicaid) improved the quality of care for your patients?

76% - No
15% - Yes
9% - No opinion

Has the move toward value-base payment (in Medicare/Medicaid) increased the regulatory burden on your practice?

90% - Yes
6% - No
4% - No opinion

Overall, has the move toward paying physicians based on value been successful to date?

79% - No
8% - Yes
13% - No opinion

https://www.mgma.com...

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The Future of Healthcare: A National Survey of Physicians

The Doctors Company

The 2018 Future of Healthcare report, compiled from the observations of more than 3,400 doctors, has uncovered a complex picture of the attitudes of physicians nationwide toward the important issues facing the industry.

43% of Doctors Believe Value-Based Care Will Negatively Impact Physician-Patient Relationship (42% No impact; 15% Positive impact)

61% of Doctors Believe Value-Based Care Will Negatively Impact Their Practice

https://www.thedoctors.com/future

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Half A Decade In, Medicare Accountable Care Organizations Are Generating Net Savings

By William Bleser, David Muhlestein, Robert Saunders, Mark McClellan
Health Affairs Blog, September 21, 2018

Summing Up

The MSSP (Medicare Shared Savings Program) like overall health care reform remains work in progress, with performance trends continuing to show improvement. While some organizations have been participating for half of a decade, most MSSP participants are still just a few years into their care transformation journey. Quality scores are generally high, the program is achieving net savings, and cost reduction is improving. But the modest savings suggest that learning from MSSP experiences to date to modify it for the future – and reinforcing these changes with other accountable care reforms – could do more to bend the curve of future cost growth. The new MSSP proposed rule would shift many more ACOs toward downside risk. But if many organizations that could have achieved savings over time drop out, and if those payments represent a small minority of total payments, even heightened downside risk may be insufficient to drive more substantial change toward a value-based health care. We are still early in the journey, but with more experience and more participants, the opportunities for evidence-based payment reforms and for shared learning to accelerate progress are greater than ever.

https://www.healthaffairs.org...

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Comment:

By Don McCanne, M.D.

The future of health care financing is all about value-based care (VBC) - paying based on value rather than volume - or so you would believe based on the proclamations of politicians and the policy community and the dissemination of that concept through the academic literature and lay media.

We are already several years into the Medicare Shared Savings Program (MSSP) through VBC experimentation using accountable care organizations (ACOs) and other alternative payment models (APMs). Two important questions to ask now about VBC are 1) How is it doing so far, and 2) What do the physicians on the front line think about it?

There are thousands of articles on VBC, but the status to date could be summed up by the recent Health Affairs Blog by Mark McClellan and his colleagues. They state that quality scores are generally high, but they are relatively meaningless since they have been pared back to measuring small bits of minutiae that are easy to game. They state that the program is achieving modest savings, but that is only in Medicare spending and it is almost negligible. When including the provider costs of complying with the program (hardware and labor) which are not included in the estimates, VBC through ACOs in the MSSP (in the language of the policy community) is resulting in higher total costs - the exact opposite of what VBC is supposed to deliver. As with so many of the academic papers on the topic, McClellan and colleagues state, "We are still early in the journey, but with more experience and more participants..." Come on.

The experiment with VBC has failed, though many are not ready to admit it. But the concept of value-based care now has a life of its own. Of great concern is that members of Congress who support Medicare for All are moving forward with changing HR 676 - The Expanded and Improved Medicare for All Act -  modifying it to include supposedly modern concepts of value-based care. But when you ask them to define specifically what value-based care is, they may reply with the meme that we will no longer pay for volume (which is untrue since even the most basic care requires a certain volume that must be funded). When you ask them to clarify what that means as far as it relates to transformation of the health care delivery system, after stumbling around, they may come up with accountable care organizations. Ask them what that is and the better informed politicians might tell you that it is an organization that is accountable for quality and costs (how astute of them). Zero in on that and ask them to define precisely what that is structurally, beginning with it being an organization to which patients are assigned without their knowledge. Got them, because  they don't know what an ACO is because a precise definition does not even exist (even though ACOs were also included in the Affordable Care Act). And yet the progressives want to change HR 676 to include VBC and ACOs within the legislation.

They don't seem to be listening to the people on the front line - the physicians who are providing so-called value-based care, often through ACOs. What do the physicians have to say?

* 79% do not believe that value-based care has been successful to date

* 90% state that value-based care has increased the regulatory burden on them

* 76% do not believe that value-based care has improved the quality of care

* 61% believe that value-based care negatively impacts their practices

The process of rewriting HR 676 has already begun. The politicians involved seem to think that they are improving this two-decades-old legislation by introducing modern concepts of value-based care. The concept may be an empty meme, but the application of the concept is already causing serious harm where it really counts - at the physician-patient interface. When we are aiming for patient care nirvana through a single payer, improved Medicare for all, we don't want to damage or destroy it by injecting into it a major element of VBC hell. Let the politicians know.

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