FAMILY PHYSICIANS CONTINUE MOVE TO NEW PAYMENT MODELS, AAFP SURVEY FINDS

Michael Laff

doi:10.1370/afm.2215

WASHINGTON -- A growing number of family physicians are making the transition to value-based payment models despite some skepticism and obstacles, according to a recent survey (http://humananews.com/wp-content/uploads/2017/11/Data-Brief2017_Value-Base_FINAL4.pdf) conducted by the AAFP.

The survey, which was sponsored by Humana, asked family physicians about their level of participation in value-based payment programs and compared the results to those of a similar survey that was conducted in 2015. Forty-seven percent of respondents in the recent survey said they are actively pursuing value-based payment programs—an increase from 44% in 2015—and 54% of practices are updating their technology systems to prepare to transition to the new payment models. In addition, awareness of the new models is growing, with 60% of physicians saying they are “extremely” or “somewhat” familiar with them, up from 57% in 2015.

A panel discussed the survey results November 29, 2017 during a press briefing on Capitol Hill that was aimed at legislators’ staff members.

One attendee asked if the new payment models would prompt physicians to change how they care for certain patients. Amy Mullins, MD, the AAFP’s medical director for quality improvement, answered that when she cared for patients in a medical home setting, she did not make note of what insurance each patient carried. “It’s not an incentive or a facilitator,” she said of new payment models. Instead, value-based payment “allows you to spend time with a patient and get paid for the things you’ve always been doing that you were not paid for in the past.”

For example, Mullins noted that CMS’ Quality Payment Program includes a bonus for treating complex patients in recognition of the difficulty of providing such care, even though she had seen no indication that physicians had been dropping these patients. Yet despite the increasing numbers of family physicians who have adopted value-based payment models, barriers to adoption still stand, remaining largely constant between 2015 and 2017. For instance, 90% of physicians cited lack of staff time in 2017, down just 1% from 2015. In both surveys, 62% of physicians cited a lack of evidence that meeting performance measures leads to better patient care. Other barriers became less frequently noted during that period, including lack of resources, which was cited by 81% of respondents in 2015 and only 74% in 2017, and ability to understand the financial risk, which fell from 80% to 75%.

Another ongoing challenge to wider adoption of value-based payment is finding a way to use non-uniform performance reports from different insurers to bolster patient care. Thirty-seven percent of family physicians said they were paid by 10 or more insurers during 2017. Compounding the problem, not only are data from these insurers often outdated by the time they reach the physician, but IT vendors have yet to integrate their systems so they can exchange the data. “The lack of interoperability is the biggest thing we hear from our members,” Mullins said. “We need cooperation from a lot of players. It’s the golden ring we’re all looking for because it’s a huge problem.”

A significant change since the 2015 survey is the growing number of physicians who reported hiring care managers (up from 33% in 2015 to 43% in 2017) and behavioral health support (up from 15% in 2015 to 22% in 2017). “More people are employing or engaging behavioral health specialists in their practice,” said Roy Beveridge, MD, Humana’s chief medical officer. “You have to take care of behavioral health or you can’t get the costs down.”

Mullins noted that moving to a new payment system is a major adjustment, but continuing the transition is important to training the next generation of physicians because it will instill in students and residents the importance of coordinating care. “Changing how someone gets paid is a big ask,” Mullins said. “A lot of physicians are skeptical that value-based payment is not showing evidence (of efficacy), but a lot are still doing it. Even those who are skeptical are moving in that direction.”