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Family Medicine Congressional Conference
Fee-For-Service Is Here to Stay for Now, Says Health Policy Expert
By James Arvantes • Washington, D.C.
Regarding newer and more innovative payment models, such as the patient-centered medical home and accountable care organizations (ACOs), Berenson said, "I do not disagree with those who say we need to be moving to new payment systems." However, he noted, these payment models typically are based on the building blocks of fee-for-service. Thus, the widespread misvaluation within the fee-for-service system may inherently flaw the newer payment models, as well. "You have to fix fee-for-service before you can end it," said Berenson.
"We are not going to have these new payment models tomorrow," he noted. "In the meantime, we have some crisis in health care delivery right now, especially around primary care."
Berenson is a firm believer in the ability of integrated health care groups to improve quality, enhance patient access and control costs. "I think we would be a better system if we had ACOs," he said.
But the ACO concept will not work unless the disparities between high-end subspecialists and primary care physicians are narrowed, he added. "You are not going to get cardiologists to participate in an ACO if they can make $500,000 a year in the fee-for-service system."
Berenson also called for population-based payment models in which a health care organization or a medical practice assumes responsibility for the health of a population of patients who are associated with the organization or practice.
"That used to be called capitation," Berenson said. "That is a dirty word. It is now called global payment."