Primer on Payment Reform: Rewarding Value Over Volume

Family physicians all across America are struggling to understand the nuances of the new health care payment and care delivery landscape. For many physicians in practice today, terms like accountable care organizations, shared savings models, risk adjustment and value-based purchasing were never mentioned in medical school or residency training. In an effort to bring some semblance of order to the maze of health care delivery systems and payment options in today's market, AAFP News Now has gone directly to policy experts and family physicians in the trenches for the latest information for this special report.

Health Care Reform Linchpin is Primary Care

Making Investment in Primary Care Vital to Health Care Future

September 21, 2012 08:15 pm — Although the overall increase in health care costs in the United States has slowed recently, there still is an overwhelming consensus that the cost of health care in this country is unsustainable and more must be done to improve the quality of care. In response to this growing crisis, public and private payers have launched scores of innovative health care delivery and payment models designed to reward the value of health care services instead of the volume of services.

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More Primer on Payment Stories

Taming Payment and Delivery Model Monsters

Experts Urge FPs to Get in the Game

09/21/2012 — Allan Goroll, M.D., wants to make sure that family physicians -- indeed all primary care physicians -- understand what they need to do to get in the health care delivery and payment reform game to ensure they have the financial resources necessary to achieve better health outcomes and get paid accordingly for the high value they create. "When you look at primary care in the past two decades, it has suffered terribly from a dysfunctional fee-for-service payment system dominated by procedural specialty interests and devaluing of primary care work," says Goroll, professor of medicine at Harvard Medical School and a practicing primary care internist.

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Separating Past From Present

New Health Care Models Learn From Past

09/21/2012 — As an FP practicing in the 1990s, FP Joe Scherger, M.D., initially was excited about managed care, believing -- like many primary care physicians -- that managed care would create a central role for primary care while promoting the delivery of appropriate care. But as the 1990s progressed, Scherger became increasingly disillusioned with managed care, concluding -- like many primary care physicians -- that managed care was more about cost control and short-changing the primary care physician than providing quality care.

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Rural America Waiting for Primary Care Payment Reform

Some Regions Reap Early Payment Reform Benefits

09/21/2012 — Even as public and private payment incentives -- created around health delivery reform initiatives -- sweep the United States, many of America's rural family physicians feel overlooked and left out. With fewer internal and external resources; less revenue; and an overabundance of older, low-income patients, FPs practicing in small-town America are hurting. Jerad Widman, M.D., a solo FP in Spring Hill, Kan., a town of about 5,400 people south of the Kansas City metro area tells AAFP News Now that his practice faces financial uncertainty. "I wish I could say the reimbursement issues have improved, but I'm still waiting for those improvements," says Widman. "There is little opportunity in this area that allows me to take advantage of the reimbursement changes that have happened in other locales."

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09/21/2012 — It seems clear that payment for health care services in the United States is transitioning from the fee-for-service model into something more collaborative. Exactly what shape that "something" will take remains in doubt, but regardless of which model or models the industry settles on, physicians will have to measure and document the care they give if they want to get paid. According to Bruce Bagley, M.D., medical director of quality improvement for both the AAFP and its wholly owned practice redesign subsidiary TransforMED, the combination of cost and quality -- designed to ensure better care and healthier patients -- is essentially about value-based purchasing.

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09/21/2012 — As the demand for family physicians continues to outpace that for other specialists and subspecialists and incentive compensation formulas transition from rewarding quantity to rewarding quality, more hospitals, health systems and large physician practices are employing FPs. That said, it is more important than ever for FPs choosing the non-ownership route to know what to look for when negotiating a contract, says Michael Burke, an attorney and shareholder in the health care law firm of Kalogredis, Sansweet, Dearden and Burke, Ltd., in Wayne, Pa.

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09/21/2012 — Robert Berenson, M.D., is an Institute Fellow at the Urban Institute and an expert in Medicare and health care policy. He served as the head of Medicare payment policy for the agency now known as CMS in the late 1990s and as an assistant director of the White House domestic policy staff in the Carter administration. More recently, he was vice chair of the Medicare Payment Advisory Commission. AAFP News Now recently sat down with Berenson to ask him about payment reform, the emergence of new payment models for health care, and the role played by primary care and family medicine in an evolving health care system.

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09/21/2012 — Family physicians are dealing with a lot of issues tied to health care reform and the introduction of a variety of new delivery of care and payment models. There are resources available, however, that can help FPs sort out one model from another and, thus, help them anticipate the future of health care for their practice.

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Health Care Payment and Delivery Models Glossary of Terms

Health Care Payment and Delivery Models

09/21/2012 — This glossary provides definitions for a number of terms related to the AAFP News Now special report "Primer on Payment Reform: Rewarding Value Over Volume."

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