Doctors don’t always embrace new medical technologies, preferring to rely on what works. Same goes for how they get paid, according to a recent JAMA survey.
The results suggest that physicians are skittish about ending the tried-and-true fee –for service payment system and dislike the alternative: capitation. In its basic form, capitation is at the center of the accountable care organization payment model. But there are avenues to make it a better alternative.
In the survey, which had 3,000 responses, only 7% were in favor of doing away with fee-for-service, and the majority showed little support for what JAMA described as paying “a fixed, bundled price for managing all care for a defined population,” or capitation. Doctors did show support for a disease management approach to care. Efforts to tackle fraud and abuse also ranked high (70% said this would have value).
Physicians were nearly evenly split on their enthusiasm for efforts to reduce health care costs by reducing access to costly care with limited benefits (51% were very enthusiastic); compare competing treatments (50%); and the use of cost-effectiveness to decide treatment (47%).
Although 42% agreed strongly with the statement that doctors could be more prominent in efforts to reduce unnecessary medical tests, most of the surveyed physicians said other participants in the health care business are more to blame. Roughly one out of three (36%) said doctors have a major responsibility to reduce cost, but trial lawyers have a major role, 60% said in the survey. Other culprits included health insurers (cited by 59%), hospitals and health systems (56%) and pharmaceutical and medical device makers (56%).
The CMS-funded ESRD Comprehensive Care Model demonstration, or renal-specific ACO, that is seeking applicants through August 30 will place the financial risk of care squarely in the lap of the nephrology care team, with the physician partnering with the renal provider. If they do well––improve quality and save money––there will be rewards at the end. But that may mean more prudent use of health care technology, more vigilant disease management, and making the patient a true health care partner.
Sources indicate that CMS has had a huge response from organizaitons in the ACO demonstration; its recently announced extension for applicants included comments by CMS suggesting the agency is willing to make modifications to the requirements of the application that will help make the ACO demonstration a success.
If the renal community wants to keep decisions about patient care out of the hands of government and in the hands of the renal care team, ACOs offer that opportunity. Fee-for-service does not. But it will require strong partnerships.
Cost-effective care doesn’t have to mean cutting corners to save money. There can be a better way of doing things. With caution, it’s time to move forward.