Family Docs Embracing Value-Based Care Despite Skepticism

MedPage Today, December 1, 2017

Nearly half pursuing value-based payment arrangements, small survey says

This article first appeared November 29, 2017 on Medpage Today.

By Joyce Frieden

WASHINGTON -- More family physicians are incorporating value-based payments into their practices, but they are still skeptical about whether it really works, a small survey found.

Nearly half of the 386 family physician respondents this year -- 47% -- said they were pursuing opportunities for value-based payment, which is generally defined as payment based on the quality and outcome of care, rather than on the volume of services provided. That percentage was up slightly from 44% in 2015, according to the survey, which was sponsored by health insurer Humana and conducted by the American Academy of Family Physicians (AAFP). However, 62% of respondents -- the same as in 2015 -- agreed that one barrier to implementing value-based payment was "a lack of evidence that using performance measures results in better patient care."

"Physicians are a skeptical bunch, and very skeptical of change," said Amy Mullins, MD, medical director for quality improvement at the AAFP, said at a briefing Wednesday morning. "It took 15 years for doctors to be convinced to give a patient an aspirin when they walked into the emergency room with chest pain ... To change the way someone's going to get paid, that's a bigger context than saying, 'Hey, take this aspirin.' But even though a lot of them are skeptical ... more of them are moving in that direction."

Other barriers to implementing value-based care contracts included a lack of uniform performance reports from payers, a lack of standardized performance measures, and the unpredictability of the revenue stream. That last item, although the percentage of physicians citing it dropped from 81% in 2015 to 76% today, is still seen as a "huge barrier," Mullins said.

In addition, "We need real-time data exchange," said Mullins. "The data we get is not actionable -- it's 6 months old, given to us in forms we can't interpret, and 10 payers send it in multiple ways we don't have time to sort through. So we need real-time data that is standardized in a consumable way for very busy physicians."

Lack of interoperability between electronic health records systems also continues to be a problem for physicians who are switching to more value-based payments, the panelists agreed. "I don't know if there's a light at the end of the tunnel on that, or not," said Mullins. "We have to have cooperation from a lot of different players to make that happen, but if we can get it to happen, it would be great."

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