Hospitals must overcome these challenges to transition from fee for service to value-based care
There’s a lot of work involved in making the transition from fee-for-service payment models to performance-based arrangements. Changes are needed to outdated delivery models, there needs to be more responsibility for care coordination, and providers are tasked with finding ways to gain a competitive advantage in the market.
Jeff Smith, senior vice president and head of U.S. markets at Lumeris, said addressing these issues positions health systems to solve the dilemma created by the industry’s long-standing structural separation of care delivery — its costs, reimbursement, and quality — by integrating actionable intelligence, information, workflows incentives and tools.
This, he said, creates a new paradigm of behaviors that drives better clinical outcomes, lowers cost and creates superior engagement and satisfaction among providers and consumers.
It’s an issue that Lumeris and Cerner are attempting to tackle with a new partnership that has created Maestro Advantage, which combines the technology of both companies and allows providers to streamline redundant services — a nagging problem in the volume-to-value shift.
These redundant services include “lengthy claims processing and reimbursement cycles, and obstacles to sharing data and records,” Smith said. “Healthcare must continue to shift its focus from a system focused on sick care to well care — a system that promotes health and wellness. The transition to value-based care is a long journey.”
The shift to value creates other challenges as well. Increasingly, providers are determining physician pay through a number of different means. The options include straight salary, compensation based on personal productivity (as has been the case in a fee-for-service world), bonus structures and tying pay to an organization’s overall financial performance.
According to a recent analysis from the American Medical Association, salary is the most common model at 52.5 percent, while productivity still accounted for 31.8 percent. Only 9 percent was based on the practice’s financial performance and bonuses comprised 4.1 percent.
Over half of physicians (54.4 percent) indicated that their compensation was based on more than one method, greater than what was observed in 2014 and 2012. Productivity was a larger chunk of compensation for private practice owners, at 44.7 percent; that number dipped to 22.3 percent for employed physicians.
Partly that’s because employed physicians were more likely to have a salary, decreasing the need for productivity to factor into their overall compensation equation, the AMA said.
The group said some physicians are likely feeling pressure to increase their productivity by doing things like increasing their patient volume, or hiring outside help to perform more menial tasks.
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