"They love the idea of going to a value- and outcomes-based compensation model, but we are all struggling with how to accomplish it," he says. "We saw a spike last year and everyone said 'Oh gosh! This is where we are going!' This year we saw a bunch of health systems say 'let's wait until we have a clearer picture of the ACA.'"
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Physicians are starting to push back too, Singleton says, but not because they're opposed to value-based compensation.
"People think they are just greedy physicians who want to be paid. Not the case," he says. "Most physicians will tell you this is the right direction for healthcare. They just want a fair formula in place, especially when you look at team-based care and integrated networks, where you have all of these different mechanisms and value components that they are supposed to be judged and paid on. There are some things that we don't know how to adjust yet. And that is what the numbers reflect."
In the coming year, Singleton says he expect providers will continue to adjust value-based compensation while waiting to see how the ACA plays out.
"You are going to see people start to increase what that total compensation affects," he says. "Even last year, when we saw that big spike, we looked at all of these different programs that entered into this value-base and found it only influenced 5% or 10% of the total compensation."
"And we have to have a better roadmap of the ACA to know how we are going to be judged and how the government is going to pay us before we can put a format in place that measures it."