Health Care Leaders Endorse Payment Reform, Higher Payments for Primary Care

By James Arvantes
11/12/2008

According to a recently released study, (8-page PDF; About PDFs) many health care leaders support a revision in the Medicare payment system to provide more money for primary care and the patient-centered medical home. That's among the findings of a survey conducted on behalf of the Commonwealth Fund and in partnership with Modern Healthcare.

Graphic illustration depicting path to health care reform

The online Health Care Opinion Leaders Survey was based on a sample of 222 leaders in the health care delivery, policy and financing fields. The survey found that 85 percent of respondents supported revising the Medicare payment system to increase payments for primary care. Seventy-four percent of respondents favored paying physician practices a monthly per-patient fee for serving as a medical home, and 77 percent supported realigning the system to pay for transitional care services.

"This report is saying that, overwhelmingly, people think we should be paying differently for health care," said Stuart Guterman, M.A., assistant vice president at the Commonwealth Fund and one of the authors of the report.

The current fee-for-service system pays for individual services, creating incentives to provide more expensive and more technical services rather than encouraging more effective, higher-quality care, according to the survey. Increasingly, Medicare patients have multiple chronic conditions, and, in many cases, they rely on separate physicians to treat each of their afflictions, said Guterman in an interview with AAFP News Now.

"There is nothing in that (fee-for-service) payment system that encourages a broader perspective on what appropriate health care is for a given patient or that encourages coordination of care across different providers and different settings," he said.

Most of the survey respondents endorsed a blended payment system that would combine fee-for-service with bundled payments, which the authors defined as "a single payment for all services provided to the patient during the year, with bonuses based on quality." Only 1 percent of respondents said they prefer the current fee-for-service system to alternative payment approaches.

"Fee-for-service tends to pay more for complicated care, more for technical care, more for subspecialty care and less for primary care," said Guterman, who noted that the survey results seem to indicate respondents want to move in the direction of bundling. However, "that doesn't mean we are paying (physicians) less," said Guterman. "We are just not paying (physicians) for things that don't help … patients."

The survey, which was conducted between Sept. 15 and Oct. 13, also found that

85 percent of respondents said fundamental provider payment reform with incentives to provide high-quality and efficient care over time would be an effective strategy for improving health care performance;
more than half of respondents said bonus payments for high-quality providers and public reporting of information on provider quality and efficiency would help improve health care;
56 percent of respondents supported the idea of Congress creating a Medicare health board that would make Medicare payment and benefit decisions within congressional guidelines; and
67 percent of respondents supported Medicare's current policy of not paying hospitals for avoidable infections patients acquire during hospitalizations, known as "never events."

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