Payment Reform recap: Demonstrating value

Following the most basic model for success in business means minimizing overhead and maximizing revenues, Dr. Mark Laitos pointed out at TAFP’s Payment Reform Summit last Saturday. For doctors in private practice and other health care providers, this means billing for as many relative value units, or RVUs, as possible at the best conversion rate, and maximizing ancillary revenue, when possible.

And while this strategy is simple enough, Laitos said it has reduced the “proud field” of medicine to “conveyor belt medicine.” Worse, as payers – including health insurers, employers, and patients to some extent – strive to minimize RVUs, the solution to the cost crisis in a fee-for-service system is to slash payment to physicians and deny care to patients.

Of course neither patients nor doctors (nor the organizations that advocate for them) would allow this to happen considering the scale needed to rein in escalating health care costs. The solution, then, as speaker after speaker suggested, is to trade the volume-based model for a value-based model. This is also the cover story of the latest Texas Family Physician magazine.

Dr. Laitos was the first to bring up the triple aim – three things a health system should strive to do: improve the health of the population, improve the patient experience of care, and reduce the per capita costs of care. This Health Affairs article goes into more depth, but it sounds a lot like the concept behind accountable care organizations – that care should be primary care-based, consider population health, empower patients, and integrate with other care providers on a macro level.

Dr. Eduardo Sanchez, a family physician and medical director of Blue Cross and Blue Shield of Texas agreed on two points, referencing a still-amorphous “virtual medical community” that aims to connect smaller practices currently organized as “onesies, twosies, and foursies” by providing them with a platform for information exchange and management.

He also brought up BCBSTX’s Bridges To Excellence program as a way for physicians to be recognized as high-performing. “Physicians will have to be able to capture data, analyze that data, and have ability to adjust what those data reveal. BTE and PQRS [Physician Quality Reporting System] are not the answer, but they are a way to get started and learn how to manage the system for quality improvement.”

Dr. Chris Crow of Plano, another speaker at the summit, asserted his strong belief in using data and analytics to measure quality and costs; he’s used it in his practice to provide better, more efficient, and more cost-effective care, and he can demonstrate this through real figures to any interested party. Dr. Crow said that once a physician has access to quality and cost measures, he or she can begin to implement changes to improve care services. Not knowing the metrics is like “driving a car without a dashboard.”

Dr. Laitos asserted that there will be winners and losers in health care reform. “The winners will be the doctors who know how to demonstrate value.”

To read more about the Payment Reform Summit, check out TAFP’s coverage published in last week’s QuickInfo e-newsletter. Also stay tuned for video recordings of the lectures to be published later this fall.

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