Changes ex­pected to be good

Modern Healthcare - - SPECIAL REPORT - —An­dis Robeznieks

For physi­cians who view a cri­sis as an op­por­tu­nity, 2013 might be a great year. By ne­ces­sity and statute, changes in pay­ment and prac­tice de­sign are coming, and that could be good, two ex­perts say.

Dr. T. Clif­ford Deveny, se­nior vice pres­i­dent of physi­cian prac­tice man­age­ment at Catholic Health Ini­tia­tives, fore­sees physi­cian com­pen­sa­tion mov­ing away from pro­duc­tiv­ity- driven models and pre­dicts physi­cians be­ing as­sessed like man­agers with pay based in part on per­for­mance ex­pec­ta­tions.

In an in­ter­view last month, Dr. Jef­frey Cain, pres­i­dent of the Amer­i­can Academy of Fam­ily Physi­cians, cor­rectly pre­dicted that Congress would pass a mea­sure sus­pend­ing Medi­care physi­cian pay cuts driven by the sus­tain­able growth-rate for­mula, and he thinks this may be the year Washington fi­nally re­places the SGR.

“No­body’s been coura­geous enough to move this for­ward,” says Cain, re­gard­ing an SGR re­place­ment. “But some­times you get more coura­geous when you’re stand­ing on a cliff.”

Cain also sees a na­tional dis­cus­sion on re­form­ing Medi­care and Med­i­caid de­sign and fi­nanc­ing with ideas on ben­e­fi­ciary age, co­pay­ments and vouch­ers all on the ta­ble.

Also, while oth­ers have called for re­form­ing grad­u­ate med­i­cal ed­u­ca­tion in or­der to avoid fu­ture physi­cian short­ages, those calls have been ig­nored and the same old un­sus­tain­able res­i­dency train­ing pro­grams keep “chug­ging along,” Cain says.

But he pre­dicts an In­sti­tute of Medicine report coming out this year will high­light pro­jected doc­tor short­ages and cre­ate the

mo­ti­va­tion to do some­thing about it. “To have the IOM say that will have an im­pact,” Cain pre­dicts. Deveny fore­sees an in­creas­ing chal­lenge to state med­i­cal boards and spe­cialty so­ci­eties to con­tin­u­ously mon­i­tor scope-of-prac­tice is­sues where other providers at­tempt to de­liver ser­vices pre­vi­ously only per­formed by doc­tors. “There will be some op­por­tunists who say, ‘We can do that,’ ” even when it’s clear they can’t, Deveny says.

Cain sees the CMS and pri­vate pay­ers mov­ing away from fee-for-ser­vice in pri­mary care and to­ward pay­ment meth­ods that sup­port the pa­tient-cen­tered med­i­cal home prac­tice model, which fo­cuses on care co­or­di­na­tion, in­creased ac­cess and qual­ity im­prove­ment.

“If you spend more money on pri­mary care, the sys­tem ben­e­fits,” Cain says.

As the U.S. health sys­tem moves to­ward more pop­u­la­tion health man­age­ment with co­or­di­nated care, Deveny sees ten­sion grow­ing be­tween pri­mary care and spe­cial­ists to de­velop bet­ter work­ing re­la­tion­ships to re­duce health­care frag­men­ta­tion.

He also pre­dicts that spe­cial­ists will gen­er­ate “a louder roar” re­gard­ing elec­tronic health records that they say slow work­flow and lower pro­duc­tiv­ity—but th­ese doc­tors may need to take an added role in EHR de­sign for their spe­cial­ties.

“Spe­cial­ists have got to take some accountability and run with it,” Deveny says. “I don’t see the world turn­ing around and go­ing back­ward.”

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