Eliminating Fee-For-Service Should Be a Given
Our health care system pays providers for the number of treatments and procedures they provide, and pays more for using expensive technology or surgical interventions. It is neither designed to reward better quality, care coordination or prevention, nor to encourage patients to get the right care at the right time. While there are literally hundreds of efforts across the country to reform payments, without Medicare’s leadership these efforts will be too small and run the risk of distracting instead of focusing health care providers on delivering better care.
Moving away from fee-for-service payments should be a “given” as we reform payment. We need a compass to make sure that what we are not just moving away from a toxic payment system, but moving towards payments that promote higher quality and more affordable care. Recently, a coalition of consumers, employers, labor and providers have come together because of their agreement on the need to transform the payment system. This group – the Center for Payment Reform – has established six core principles that should guide both public and private payment policies:
1. Reward the delivery of quality, cost-effective and affordable care
2. Encourage and reward patient-centered care that coordinates services across the spectrum of health care providers and care settings – which must include increasing payments for primary care, while reducing payments and generating savings in other areas
3. Foster alignment between public and private health care sectors – meaning we must recognize that it is an entire health care system that must be made higher quality and more affordable, not either the public or private sectors
4. Make decisions about payment using independent processes – decisions about payments need to be steered by those who receive and pay for care, not just by those who deliver services
5. Reduce expenditures on administrative and other processes
6. Balance urgency to implement changes against the need to have realistic goals and timelines
Using these principles as guidance, we must design payment systems to reward providers for giving the right care at the right time and encourage patients to be actively engaged in their care. Employers, consumers and providers needs to be engaged in the coming months to be sure that we are indeed following these principles.
Comments
2 Responses to “Eliminating Fee-For-Service Should Be a Given”
Leave a Reply
None of this can be achieved until the fundamental problem of access is corrected. When people can not get in to see their primary doctor, they go to the ER. When people dont have insurance, they go to the ER. The majority of the patients I see do not need emergency services, they go where they do not have to pay. Where else can you go, DEMAND the highest level of care and quality with absolutely no plan or intent to pay. All to often people call EMS for nothing more than a ride to the ER. Until the preception of the ER is changed people will always access the most expensive form of health care, the ER.
Our health system is broken. We spend twice as much as any other country to get results that rank us at the bottom of the barrel of industrialized countries. Medicare will be insolvent by 2017. Insolvent, as in unable to pay for the care that has been promised to generations of Americans. And this only mirrors the pressures on the jigsaw puzzle that is private insurance. Here double digit annual cost growth threatens the basic competitiveness and productivity of our companies in the global marketplace. Many large companies are becoming, in the words of an executive, health care companies that happen to manufacture X, Y, or
Z. We have unconscionable disparities and a festering reality of 50 million uninsured (and growing). To add insult to injury, most doctors are gravitating to highly specialized, high cost specialties that do not promote the prevention
and chronic disease targets that will actually improve care for the population as a whole. We don’t reward value in our system, just quantity of care given out on rotating hamster wheel (much of which is no good). The question for me isn’t “why reform this year”, but rather “how can we afford not to”. There is a way
out of this mess. It will require a rational approach to promote system value over quantity of services provided, and it will require physician engagement. Physicians need to make their voices heard so that they can advocate for a more sane system that helps their patients and improves their work environments. If they don’t then others will impose a change upon them.
Doctors for America is a grassroots organization that seeks to engage physicians in healthcare reform and give them a voice in the process. Our goals are to gather physician support for heath reform this year, to tell the public and congress that physicians support health reform, and to provide an opportunity for physicians to speak out and have their voices heard. As doctors, we see the effects of our broken health system on our patients every single day. We have seen what happens when our patients are denied the care they need, or when they lack access to preventive care, or when they cannot afford their medicines. We know what’s wrong with our health care system — and have ideas about how to fix it. Right now, we are working towards educating physicians and the public about the major issues in health reform, dispelling myths and attacks about health reform, and conveying the opinions of physicians to Congress and the media. We have over 12,000 physicians who support health reform this year, and that number is growing every day.