Value-Based Payments Hurting Specialists
By Christine Kern, contributing writer
Specialists may be forced to close or merge as a result of Medicare’s value-based approach.
A survey conducted by the Physicians Foundation has found specialists may find themselves forced to close their practices or merge with large providers when Medicare’s value-based approach to reimbursement takes effect.
The Physicians Foundation’s 2014 Survey of American Physicians is intended to “take the pulse” of physicians and offer a “check-up” of the medical profession by creating a snapshot of physician morale, practice plans, practice patterns, and professional perspectives. The survey was sent to over 80 percent of doctors in all active patient care, or some 650,000 physicians, to reveal their perspectives on the healthcare system.
Specialists, whose practices have traditionally thrived under fee-for-service rules, said patients in rural areas may have trouble finding specialists under the new reimbursement protocols. Only 35 percent of physicians described their practices as independent, down from 62 percent just seven years ago, the survey reported.
“You’re really losing ready access in many parts of the country that are rural,” Bruce Sigsbee, a neurologist who works for a hospital system in Rockport, ME and immediate past president of the American Academy of Neurology, told Bloomberg Business. “There does seem to be a perceived push for people to leave independent practice by these policies.”
“Avoid single payer without a private alternative,” commented one physician in the survey. “And stop this silly talk about doing away with fee-for-service. It will only increase the movement of physicians becoming clock-watching salarymen.”
As Healthcare Dive points out, there is a deep generational divide among physicians revealed by the survey. Whereas 90 percent of new physicians are participating in ACOs – as opposed to opening up or working in independent practices – older physicians are still clinging tightly to the independent model.
“While some physicians have elected to participate in new delivery models such as ACOs, and while most have adopted electronic medical records, many are dubious about the benefits of these models and systems and do not believe they will achieve cost or quality gains,” the survey states. “Though one-third of physicians participate in state or federal exchanges/marketplaces established by the Affordable Care Act, close to the same number have no plans to do so. Almost half of physicians give the ACA a low to failing grade, while only one quarter give it a positive to excellent grade, though opinions of the ACA and many other topics vary among 'new guard' and 'old guard' physicians.”
The U.S. health secretary, Sylvia Mathews Burwell, announced Jan. 26 she wants at least 30 percent of Medicare’s $362 billion in fee-for-service payments moved, by 2017, into new programs that demand accountability from doctors and hospitals and in some cases penalize them if their care doesn’t meet quality and efficiency standards. The fraction would rise to 50 percent by 2019.