Tuesday Dec 05, 2017
Value-based Payment? Survey Says …
"Charlie, here comes the deuce. And when you speak of me, speak well."
-- Kevin Costner as Crash Davis in Bull Durham
I hope each of you had a nice Thanksgiving and you were able to spend some quality time with family and friends. I had a nice holiday, and I enjoyed the opportunity to engage with many of you on the important and thoughtful comments you provided to my previous post. As I read a couple, I was reminded of the great quote above from the classic movie Bull Durham. This blog is designed to inform, educate and engage family physician on timely policy and political activities in Washington, D.C., and around the country. It also is intended to stimulate debate -- a process that informs and educates the Academy on members’ views and attitudes towards those same issues. Just remember, no matter our alignment or differences on individual policies, we are all on the same team and we all want the same things. So, let's keep up the good discussion on a non-controversial topic -- value-based payments!
During the past decade, there has been a sustained effort to transform the health care delivery system to better align payments with quality and performance. Although some aspects of practice transformation have always been a part of our health care system and policy environment, there certainly has been an increase in activity since the early 2000s.
The current approach towards quality and performance improvement began in the early 2000s with what was initially known as the Physician Quality Reporting Initiative (PQRI). In the past 10 to 12 years, we have seen quality improvement and practice transformation concepts such as PQRS, value-based modifier, meaningful use, patient-centered medical homes, accountable care organizations and several others that have been implemented by insurance companies. Despite some variations, today, we have largely coalesced around the concept of value-based payments (VBP).
I recognize that terms like transform, better align, quality, and performance tend to kickstart a healthy debate among family physicians, and few phrases cause the elevation of blood pressure quite like "value-based payments," but I still think it is important to share some thoughts on this subject.
Providing high-quality health care in the most efficient manner possible is a goal that is easily supportable and without question one that our members strive to achieve each day. How you go about achieving that goal within your individual practices is a question that lends itself to analysis, so we decided to do some analyzing.
This summer, the AAFP partnered with Humana to survey family physicians regarding their engagement with, and attitudes toward, value-based payment models. This is the second time the two organizations have partnered on such a project. In 2015, shortly after the enactment of the Medicare Access and CHIP Reauthorization Act (MACRA), the two organizations conducted a similar survey. The results are interesting both in the progress that has been made among family physicians, but also in the fact that the barriers identified in 2015 persist today.
My colleague, Amy Mullins, M.D., summarized the findings this way during a congressional briefing on Nov. 29: "Progress continues toward value-based payment, but major barriers still stand in the way." The survey was comprehensive, but I have pulled some key findings that demonstrate where progress has been made and the barriers that continue to exist. The following questions are taken directly from the survey.
How familiar are you with the concept of value-based payment?
Sixty percent of respondents said they were extremely and/or moderately familiar with the concept of value-based payments. This is a slight increase from 2015. What is most interesting is the number of family physicians who responded that they were "not familiar at all" dropped from 12 percent to 7 percent.
What is your current status or strategy towards value-based payment?
Forty-seven percent responded that they were actively pursuing VBP opportunities in their practice. Twenty-one percent responded that they were developing capabilities, but are waiting until results are better known. All told, more than 65 percent of family physician are either participating in a VBP model or preparing to do so in the near future.
What changes to your practice are you making or have been made to participate in value-based payments?
- Fifty-four percent responded that they are updating or adding health IT infrastructure.
- Forty-three have hired or are hiring care coordinators.
- Twenty-two percent have hired or are hiring behavioral health support.
- Fourteen percent are not making any changes.
What are the major barriers to value-based payment models?
- Ninety percent stated the lack of staff time to implement care functions that support VBP.
- Seventy-five percent responded that the lack of uniformity across payers was a major barrier to VBP.
- Seventy-eight percent stated that the lack of standardized performance measures and metrics was a major barrier.
- Seventy-six percent said the unpredictability of revenue was a major barrier.
As part of the survey, the AAFP took a deeper look at the payer mix of family medicine practices, which is illustrative of the concerns raised regarding the lack of uniformity across payers and the lack of standardized performance measures and metrics. Thirty-seven percent of respondents have contracts with 10 or more payers. Almost 60 percent have contracts with seven or more payers. Clearly, the variation amongst payers is a major barrier to VBP and a major source of frustration.
One of the more interesting findings of the survey is the high level of skepticism that continues to exist regarding the value of value-based payment models. Sixty-two percent of respondents stated that there is a lack of evidence that using performance measures results in better patient care, and 58 percent think VBP will increase the work for family physicians without benefiting the patient.
My final observation is the continued frustration with the functionality of electronic health records, data registries, and clinical data repositories. These items continue to be prominent barriers identified by those physicians seeking to implement VBP models in their practice -- their EHR and other technology platforms simply do not help them.
On Dec. 19, the AAFP will formally present our Advanced Primary Care Alternative Payment Model (APC-APM) to the Physician-Focused Payment Model Technical Advisory Committee (PTAC). We are excited to share this patient and family physician focused payment model with the PTAC, and we are optimistic that the model will be forwarded to CMS for further testing. Watch @aafpprez(twitter.com) and @rshawnm(twitter.com) Twitter handles for real-time updates on Dec. 19 and watch AAFP News for a detailed summary of the PTACs actions.
Posted at 09:00AM Dec 05, 2017 by Shawn Martin