Physicians are receptive to alternative care models, but face daunting challenges, an AMA/RAND report says.
Physicians moving toward alternative payment models are overwhelmed by reams of confusing quality metrics and data from the government and commercial payers and will need help sorting it, according to a new study from the American Medical Association and the RAND Corporation.
"We face the paradox of too much data being directed at physicians, yet there is a dearth of accurate, actionable, and timely information," AMA President-elect Steven J. Stack, MD, said in teleconference with media on Thursday.
Stack says the AMA/RAND report shows that physicians are receptive to alternative care models, but face daunting challenges.
"More needs to be done to streamline and harmonize quality metrics. There is far too much variability in the large array of quality metrics being promoted by multiple payers, both commercial and public," Stack says. "Many of these metrics are not validated, nor is there accuracy in the data being reported back to physicians."
The time and effort spent "managing metric variability for each health plan requires significant resources that could be better spent on the investments practices need to succeed in alternative payment models," Stack says.
How to Accelerate Progress Toward a Value-Based Future
RAND researchers examined 34 physician practices in six markets to note the effects that alternative health care payment models are having on physicians and medical practices. The payment models include episode-based and bundled payments, shared savings, pay-for-performance, capitation, and retainer-based practices, accountable care organizations and medical homes.
The study found that many physician practices are partnering or merging with other medical practices or hospitals to better support the costly investments needed to succeed with new payment models, such as care managers and information technology. Practices leaders told researchers that realigning their operations to the goals of the new payment strategies is a challenge when data are not available or different payment models conflict with each other.
"Physician practices need support and guidance to optimize the quantity and content of physician work under alternative payment models," Mark W. Friedberg, MD, the study's lead author, an internist, and a senior natural scientist at RAND, said at the teleconference.
The report found that most physician leaders were optimistic about alternative payment models, while physicians not in leaderships were apprehensive, particularly with regards to new documentation requirements. There were also concerns that the new data would increase "busy work" at physicians' expense.
"Many of them were very concerned about physician burnout to the extent that participating in an alternative payment model and requiring different work also added to the total amount of work that physicians were doing," Friedberg says.
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While most of the physicians queried in the report agreed that the transition to alternative payment models has encouraged the development of team-based care for chronic diseases, they also believe the failure to address their concerns about the complexity of data metrics and requirements could impede the potential for value-based care to improve quality and lower cost.
"Harmonizing key components of alternative payment models, especially the performance measures, would help physician practices respond constructively," Friedberg says. "All that effort spent wrangling the measures and trying to synthesize them into something actionable could be spent elsewhere and practice leaders could more fully devote their efforts to care improvement for patients."
John Commins is the news editor for HealthLeaders.