Most Physicians Not Prepared for Value-based Care Transition

by | Last updated Dec 8, 2023 | Published on Dec 11, 2017 | Medical Coding

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Care TransitionValue-based care is different from the current fee-for-service (FFS) model of care, which simply pays for the number of services a patient receives. With the U.S. healthcare system now shifting from FFS model to value based care, healthcare providers’ compensation will be based on keeping a population healthy than on how many tests or services are ordered. Experienced medical billing companies are also offering extended helps for physicians to meet their transition requirements. While several large commercial insurers including Aetna, Anthem, UnitedHealth Group and Cigna are shifting most of their reimbursements to value-based models, reports indicate that not all physicians are prepared for this transition. The “2017 U.S. Front Line of Healthcare Survey” conducted by Bain and Company shows that more than 70% of physicians prefer to use a fee-for-service model, referring to concerns about the complexity and quality of care associated with value-based payment models. 980 physicians in eight specialties, 100 finance officers and 100 procurement officers participated in this third Healthcare Survey.

The survey results show that physicians now want evidence that new models for care management, reimbursement, policy and patient engagement will actually improve clinical outcomes.

Key findings of this survey include:

  • More than 60% of the physicians we surveyed believe it will become more difficult to deliver high-quality care in the next two years as they struggle to cope with a complex regulatory environment, increasing administrative burdens and a more difficult reimbursement landscape.
  • While physicians not engaged with their firms have more reasons to resist new structures and systems, those who play a role in management decisions are much more satisfied with their working environment and more willing to lead change.
  • 53% of physicians say that capitation reduces the quality of care, and most see little advantage from pay-for-performance models either. Further, many believe their organizations are not sufficiently prepared for the shift to value-based care.
  • Many doctors also believe that their organizations are not sufficiently prepared for the shift to value-based care.
  • Recognizing the continual pull in the industry toward the value-based approach, many organizations continue to experiment with value-based care as part of a mix of payment models.
  • Physicians in management-led organizations are less satisfied and less aligned with their organizations’ missions than those in physician-led organizations.
  • 70% nonsurgical physicians believe payer restrictions such as prior authorization requirements limit their prescribing decisions, and 59% believe these restrictions decrease their ability to deliver high-quality care

Providers that want to move toward value-based payment models can generate greater support by working closely with their physicians to shape these models and addressing their concerns about outcomes, simplicity and fairness to all stakeholders.

According to another survey by the American Academy of Family Physicians and Humana, major barriers among physicians to implement value-based care delivery are lack of staff time to implement care functions that support this payment method, no uniform payer reports on performance, lack of standardization of performance measures and metrics, and unpredictability of revenue stream. Also, more than 3 in 5 of surveyed physicians said there is a lack of evidence that using performance measures results in better patient care, which is the same 62% even in 2015. Also, a few major changes that have been made to participate in this payment method are updating or adding health IT infrastructure and hiring care management or care coordinators and behavioral health support.

However, the latest announcement from AAFP and Humana is that despite skepticism, about 47% of family physicians are taking on value-based reimbursement, up from 44% in 2015. Practices are also investing more in care coordination capabilities to support value-based reimbursement models. It is expected that more doctors will make the switch to value-based care as they realize that it also includes more pay for meeting quality measures, coordinating care, preventing repetitive treatments, controlling overall costs and improving health outcomes. Professional medical coding services will be an asset for physicians to achieve efficiency under the value-based care system.

To know more about Value-based Care Transition we have written a new blog on July 30, 2018 “60% Doctors Still Not Familiar with MIPS, Finds Study

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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