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In the fee-for-service world, physicians need to squeeze in more visits into less time. Here’s how value-based reimbursement is changing the model.
Is value-based reimbursement helping physicians spend more time with patients? If you ask Farzad Mostashari, CEO at Aledade, a Bethesda, Maryland-based accountable care organization (ACO) services company, the short answer is yes.
In the fee-for-service world, physicians need to squeeze more visits into less time to experience a revenue increase. By way of contrast, in the value-based care model, providers have a set amount of money allotted to take care of each patient, and can then choose how to invest that money. As a result, it makes much more sense not to send patients to different specialists-at least not until the primary-care physician can spend more time with the patient to determine their health status, says Mostashari, who previously served as the U.S. National Coordinator of Health Information Technology.
In an outcome-based payment system, it also makes sense for primary-care doctors to spend more time with their sicker, more complicated patients, to prevent avoidable complications, unnecessary emergency room visits, and preventable hospitalizations, says Mostashari.
In the ACOs with which Aledade works, doctors are spending more time with their patients, especially those at highest risk. For example, patients are being called within 48 hours of discharge from the hospital to see how they are doing back at home. In addition, patients’ medication lists are reviewed, and they are seen in person by their primary-care physicians, he says. “We have found that these extra visits and attention are not only good for the patients, but they also save the system money: reducing readmissions in the highest risk group from 33% to 20%.”
While value-based reimbursement has perks for physicians, healthcare executives must keep in mind that the transition to value-based care is also going to be painful, says David Muhlestein, senior director of research and development at Salt Lake City, Utah-based-based Leavitt Partners. “Learning new skills and performing similar services but in a new way is not easy,” he says.
Many providers are still in their first or second year participating in ACOs, and they have a long way to go to make the necessary changes for success. “One year is way too short a time to make fundamental changes to the delivery of care,” he says.
GardnerSay, for example, a healthcare organization wanted to standardize the way its providers care for diabetic patients, says Paul Gardner, a manager on the ACO team at Leavitt Partners. The healthcare system would want to kick that off by forming a committee of its best providers. Even identifying its best providers would require analysis, and then it would need to organize the committee, reach consensus, document the protocol, and then train its staff on the new protocol.
Physicians are accustomed to dealing with the process of care-as opposed to the outcomes, says Muhlestein. “Physicians got into the practice of medicine because they like to interact with patients … what’s different [in value-based care] is their breadth of responsibility is starting to change. It’s no longer just when the patient is in front of their doctor that the doctor is responsible for their care. And that’s a fundamental change for physicians.”
A good way to help physicians through these growing pains is by communicating clearly what is expected and by making it clear that those expectations aren’t going away, says Gardner. Still, healthcare systems can’t just load on additional responsibilities without removing previous responsibilities or expectations. For example, if physicians are expected to devote more time to educating patients or coordinating care with other providers, they may not be able to sustain the same volume of patient visits.