Splitting the American health care dollars

There has been much discussion about American health care being too expensive and unsustainable.  In response, the Center of Medicare and Medicaid Services (CMS) started piloting Accountable Care Organizations (ACO), which are healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients.  Private health insurers have also begun to experiment with various model that has its goal partly in controlling the cost of care.

Amongst all these changes, you may be curious as to how the physician community looks at this new wave of compensation reform, after having gone from Managed Care (HMO) to PPO in the last 30 years.  An article on the American Medical Association website titled How to split the health care dollar shed some light on the internal discourse among doctors.

The author said that physicians need to decide when and how they would make changes in how they practice and get paid.  Opting out of this round of payment reform and staying with fee-for-service is not really an option.   Being an early mover may in fact allow a doctor to participate in the design of the new framework.

The author expressed optimism that the payment reform this time around will be different from past attempts because the stakeholders now have more data and analytic tools to help them distribute the health care dollars efficiently while driving better quality of care.

Unfortunately, small practices do face the issue of being excluded from participating in new payment models.  Nevertheless, the author said there are options other than selling out to large groups or hospitals.  Small practices can participate in other systems that might be regional alliance, independent practice association, etc. 

Other innovative options for doctors to stay economically viable in a small practice include becoming a super-specialized clinician or a concierge practice. In fact, I have also seen clinics turning into Direct Pay practices for the general public.

At the end of the day, what advice did the author dispense to her physician readers?  She essentially said things are tough right now but doctors have to participate in and even drive this change in payment scheme.  Eventually, it will be better for their business.

Let's hope for the sake of patients and the health care system, we do get to the end of the rainbow, where the quality of care is improved and the cost to provide care is lowered.  Do you share this optimism?