American College of Physicians Pushes Payment Reforms to Increase Value and Equity
The company of internal medicine specialists urges to redouble its efforts to shift from volume-based physician payment to value-based payment models.
The American College of Physicians (ACP) offered a seven-part program series of reforms link physician compensation to value and equity rather than volume of services.
Since the passage of the Patient Protection and Affordable Care Act in 2010, policymakers and legislators have sought to replace fee-for-service reimbursement in health care with value-based payment models. Despite more than a decade of effort, a recent study found that physician compensation is still largely based on the volume of services rather than the value of services.
The ACP is made up of specialists and sub-specialists in internal medicine. With more than 160,000 members in several countries, the CPA is the largest medical specialty society in the world.
This week, the CPA released the organization’s seven-part set of reforms on paying doctors in a stand in Annals of Internal Medicine. Physician payment models dominated by fee-for-service approaches do not promote value or equity in health care in the United States, the position paper states. “Socioeconomic factors remain one of the most clinically significant contributors to health outcomes in this country, but the current fee-for-service structure encourages volume and fails to account for these factors. ‘American College of Physicians offers specific policy recommendations on reforming payment programs, including those designed to address underserved patient populations, to better address the value of health care and achieve greater equity.’
The position paper says there is a need to design “smarter” healthcare payment models. “The approach of building a health system that is smarter about how dollars are spent to improve people’s health must shift to one with a clear intent to reduce health inequities and tackle social drivers of health.”
The position paper calls for more meaningful efforts to create value-based payment models. “Political leaders and the clinical community must work together to move towards equity using value-based payment. For more than a decade, policy goals have emphasized the need to achieve greater equity, but the the fact remains that the execution of these policies continues to lag. Now is the time to set a national intent to build on this experience and support the implementation and evaluation of payment approaches to advance the health equity and overcoming social factors and other disparities that lead to poorer health outcomes.
The CPA is calling on Medicare and other payers to develop prospective, population-based payment models for primary and comprehensive care. These payment models should support access to care and address health care disparities and inequities related to personal characteristics and/or social drivers of health. New payment models should be designed to improve care for underserved patient populations.
Research should be conducted to measure the cost of caring for patients who are impacted by health care disparities and inequities based on personal characteristics and/or social drivers of health. In value-based payment models, performance and cost measures must be adjusted for risk, health status, and social factors of health. Performance and cost data should be used to improve the value of primary and comprehensive care.
The Health Insurance Act should be amended to establish a means of calculating savings resulting from increased investments and payments for primary care and preventive health care services (Part B) that reduce visits to emergencies and hospitalizations (part A). These savings should be reinvested in primary and preventive care as well as social and public health services. Investment in primary care should not be based solely on short-term savings, as primary care improves the health of the population and some savings are realized over several years.
The Federal Secretary of Health and Human Services should reform Medicare Quality Payment Program to ensure that the program addresses inequities, health care disparities and social drivers of health. New financial policies and approaches should encourage medical practices to adopt value-based payment models.
Delivery and payment systems should help clinicians and health facilities deliver care to patients when and where they need it in a range of modalities, including in-person visits and telehealth. This approach to care is particularly important for patients struggling with health care disparities and inequities based on personal characteristics and/or social drivers of health. These delivery and payment systems should not increase the administrative burden on clinicians or inappropriately challenge clinicians’ judgment.
Funds should be allocated to the development of health information technology systems and communication capabilities such as broadband so that delivery and payment reforms meet the needs of all patient populations. These capabilities should help patients who experience health care disparities and inequities related to personal characteristics and/or social drivers of health. Policies promoting these capabilities should not unintentionally redistribute resources from at-risk patients or create incentives to avoid at-risk patients.
Health actors, including policymakers, payers, health systems, private sector investors and philanthropic organizations, should develop funding mechanisms other than direct payment to clinicians, such as grants to remedy inequalities, health care disparities and social drivers of health.
Related: Value-based care is making progress, but the transition is proving difficult
Christopher Cheney is the Clinical Care Editor at HealthLeaders.