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Primary Care Physicians Dissatisfied and Confused By Payment Models

Tuesday, December 15th, 2015

Many primary care physicians are not convinced that planned delivery system changes will lead to quality improvements. This uncertainty could have a major effect on the future of American health care as almost half of primary care physicians responding to a recent survey indicate they are considering early retirement rather than operate under these new systems.

According to the results of a joint survey sponsored by the Kaiser Family Foundation and the Commonwealth Fund that are summarized in this infographic, this uncertainty about new practice models includes physicians who have had early experience with alternative payment structures such as accountable care organizations.

Results of the survey revealed a split decision. Almost half of the physicians – 47 percent of those surveyed – said they were considering early retirement because of trends they see in the way health care is being delivered. Slightly more than that – 52 percent – said their retirement plans currently remain unaffected or they may delay their retirement.

Part of the uncertainty among physicians who are not converts to increased dependence on value-based models may arise from the perceived complexity of payment arrangements. Thirty eight percent of the primary care physicians surveyed verified they were currently participating or preparing to participate in an accountable care arrangement under Medicare or with a private insurer. Of those participating, the majority favor private payers over government options for both the amount of reimbursement as well as the administrative ease of obtaining payment.

Shockingly, 28 percent of surveyed physicians said they weren’t sure about the details of their practice’s payment arrangements.

In the current health care environment, where payers and policymakers are seeking to incentivize better care delivery at a lower overall cost, physicians unaware of their payment arrangements may feel lost in a sea of competing requirements. If the success of early accountable care organizations is going to be replicated across America, previously unaffiliated providers must enter the accountable care continuum by designing clinically integrated networks capable of delivering on the promise of population health at an affordable cost.

The perspectives revealed by this survey of primary care physicians show the dangers of not directly involving physician leaders in the development of clinically integrated and accountable care delivery systems.

Accreditation standards developed by clinicians and leaders of successfully integrated and accountable care organizations recognize and organize structures and processes for creation of clinically and financially integrated practice networks with physicians at the helm. Accreditation offered by URAC was created to enable such networks to demonstrate their commitment to quality processes and outcomes for the populations they serve.

The URAC standards have been utilized to guide the development of cohesive clinically integrated networks that grew in capability to become accountable care organizations. In such a unified organization, leaders have clearly communicated agreed-upon goals for clinical improvement to drive the way care is delivered and financial integration is accomplished.

Primary care physician attrition could harm efforts to deliver more accountable care and improve population health. Achievement of accreditation offers a means to build effective organizations led by committed care teams while meeting the health care aims of a new era. No one sets out to fail, but many have. URAC Clinical Integration accreditation and Accountable Care accreditation can help.

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For 25 years, URAC has been the independent leader in promoting health care quality through accreditation, education, and measurement. URAC offers a wide range of quality benchmarking programs that reflect the latest changes in health care and provide a symbol of excellence for organizations to showcase their validated commitment to quality and accountability. URAC’s evidence-based measures and standards are developed through inclusive engagement with a broad range of stakeholders committed to improving the quality of health care.

For more information about URAC, contact us.

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