Sen. Baucus noted that physicians seem caught in what he described as "stove pipes of care. How do we get rid of some of these pipes?"
Speaking for the American Medical Association, Ardis D. Hoven, MD, said that a variety of new models of care coordination and payment such as medical homes and bundled payments hold promise of a more flexible system and will help. "We have to be accountable as physicians to make sure we are getting the job done and producing outcomes and quality in our work. These new models that are being tested now are going to give us that information, which we have never had before," she said.
There was general acceptance among the five speakers that while the SGR should be repealed, no single payment replacement system would suffice. Glen Stream, MD, president of the American Academy of Family Physicians, described a blended payment system—common among patient-centered medical homes—that includes a combination of fee-for-service (FFS), care management fee, and quality improvement payments.
FFS would cover procedures, treatments, and services; the care management fee would pay for continuity of care within the care coordination team, and quality improvement payments would reward physicians who use patient data to improve care.