Skip to main content

Physician Payment Reform Gets Serious

 |  By jcantlupe@healthleadersmedia.com  
   March 08, 2012

As Steven A. Schroeder, MD, begins his work as chairman of the new National Commission on Physician Payment Reform, there's one thing he wants more than anything: that his group's findings don't end up collecting dust on a shelf.

The 13-member commission has been formed to examine physician payment structures, including the impact of the annual Medicare reductions to doctor salaries, and the focus of Accountable Care Organizations (ACOs).


LIVE Webcast: Marketing to Overcome Physician Recruitment Hurdles
Save time and money by targeting, recruiting, and retaining "best-fit" physician candidates using proven marketing tactics. Featuring three marketing and recruiting industry leaders from diverse regions, hospital sizes, and backgrounds, this March 30 webcast has a new format that allows you to pre-submit questions to our speakers to get the answers your organization needs.

Register Now


The doctor-centric panel boasts as honorary chairman former Sen. Majority Leader Bill Frist, D-TN, who has bona fides as a heart and lung transplant surgeon.  Frist tells HealthLeaders Media he fully intends to be a working member of the group.

Other members include hospital medical directors, academic research specialists, and representatives of WellPoint, CVS, and the Brookings Institution.

The group will meet over the course of one year, and its goal is to produce a detailed analysis and recommendations on physician pay by early 2013. Launched by the Society of General Internal Medicine, the commission is funded by the Robert Wood Johnson Foundation, the California Healthcare Foundation, and the Sergie Zinkoff Fund for Medical Education and Research.

Frist says the commission will focus, in part, on what he sees as a great divide among politicians and clinicians in response to healthcare policy.

"Much of the policy in Washington D.C. is driven by the budget and deficits, entitlements, and Medicare," Frist tells HealthLeaders Media.  "All of that is fine, but the health service aspect is usually the aspect that is ignored in Washington, D.C. Typically, health service delivery is overlooked by the Washington D.C. budgeteers. This commission gives us the opportunity to marry both camps, which too often end up with conflicting views on the issue of physician reimbursement."

"Physicians are drivers of most of the healthcare dollars," adds Frist, "but too often they are not at the center of healthcare reform discussions."

The commission started work last week with Schroeder, former president of the Robert Wood Johnson Foundation and professor of health and health care at the University of California, San Francisco. He predicts that the panel would "comment on challenges" facing the different physician payment formulas.

"Doctor payment is such a critical issue now," Schroeder says, ticking off a mind-boggling list of concerns. Among the ones he cited: the SGR (sustainable growth rate) payment formula; geographical and specialty distribution of physician pay, and the increasing demands for physician services, such as primary care. Of further concern is the overall impact of healthcare reform, especially related to the currently uninsured.

Talking to Schroeder, you get the sense that the commission may not be up for political fights, like the one currently dogging the SGR formula. That formula, which many physicians simply want to banish forever, is the center of continued dallying by Congress over specific funding.

Most recently, lawmakers passed a 10-month patch to stop potential 27% cuts to Medicare payments to physicians that would have begun March 1. The agreement was the 14th short-term "doc fix" to the SGR in the past 10 years, according to the American Medical Association.

The Frist and Schroeder commission isn't likely to do anything dramatic to influence the SGR, so don't hold your breath. But it's extremely early, so who knows?
Schroeder downplayed any potential fistfights over SGR. "Right now I look at that as a very important contextual issue, but probably fixing it is outside the scope of what our commission is going to recommend," Shroeder says. "It's up to Congress. They are getting lots of advice, from kicking the can down the road to granting a waiver to other kinds of things."

While the commission may make some note of the SGR issue, it isn't likely to create a lot of noise. That's a disappointment.

When it comes to ACOs, though, the commission may engage in some in-depth discussions, and that's welcome.

Schroeder immediately raised some questions about the framework of ACOs in the interview with HealthLeaders Media. "I think there's a gap between the rhetoric and the hope for ACOs, and the potential number of people who will be covered by them in the short run," he says. "I think it's going to be difficult to create from whole cloth."

Although Schroeder didn't exactly tip his hand about where the commission may be headed on ACOs, the fact that he raised even the slightest question is good news that there will be some debate about ACOs.

Other parts of the commission's agenda on potential physician payment plans includes an in-depth look at patient-centered medical homes and value-based purchasing. "Those organizations will be considered to the extent that payment reform is featured," Schroeder says.

Besides exploring how physicians are paid, and indeed, how much, the commission will examine questions about patient treatments and various aspects of services and technology as well as the evolving healthcare funding from fee-for-service to quality, Schroeder says.

There's no doubt the country has to change its funding for healthcare, with physician income a part of it, Schroeder says. "Our demand for care outstrips our ability to pay for it. That's what every country wrestles with. We have features that make us a real outlier.  We spend a lot, and people are concerned we don't have great value."

 

Schroeder continues: "if we move toward bundled payments or capitation, (we can look) at the ways we can maximize value, transparency and good conduct. Those would be the principles going in to our discussions, and can be modified as other members weigh in."

The commission will look at efforts to incorporate quality into the current pay system and assess the opportunities and risks of the healthcare payment configurations, such as those implemented in the ACOs, according to Schroeder. In addition, members will consider incentives and safeguards surrounding forms of physician payment that may maximize good clinical outcomes, Schroeder says.

"I am daunted by the charge we have, and hope we are up for it, because it is such an important issue," Schroeder says of the commission. "A lot of commissions I've been on and read about, a report winds up sitting on a shelf. We want people to say at the end of this that our findings really made sense and it's going to be helpful."

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
Twitter

Tagged Under:


Get the latest on healthcare leadership in your inbox.