Capitation

Does Payment Reform Save Money? Comments on the Attorney General’s Report

Posted in Accountable Care Organizations, Capitation, Global Payments, Payment Reform on June 24th, 2011 by MMS – Comments Off on Does Payment Reform Save Money? Comments on the Attorney General’s Report

By Lynda Young, MD, MMS President

Attorney General Coakley’s new study this week on health care costs and payment reform has been generating a lot of discussion. Here are some thoughts from our corner.

We think it’s too early to declare payment reform a failure from a cost-cutting perspective. You can’t measure its effectiveness after just one year. Five years is a far more reasonable time frame to declare victory or defeat.

Further, the implied threat of more top-down rate regulation greatly concerns us. It hasn’t worked in the long run, because players always find a way around the rules and the unintended consequences are too great.

But we don’t want to be entirely negative. We applaud the attorney general’s observation that a variety of organization models can be effective, and that both physician-based and hospital-based groups can get the job done.

But perhaps the most important part of the report discusses risk management and risk adjustment.

As the attorney general noted, most physician groups are ill-equipped to handle significant financial risk today. To do so in the future, we will need much better data than we currently have. We will need a clear picture of who is in our practice group, their utilization patterns, and what they do when they seek care outside our group. Without this, it will be impossible to monitor our own efficiency or quality.

We also need good electronic health record systems that can communicate with physicians outside our practice. By and large, this is not possible today. Imagine how limited your cell phone would be if you couldn’t call someone who’s using a different cell phone provider. That’s pretty much what most EHR users face today.

We also need to ensure that physicians can stay in small practices if they want to, while enjoying the benefits of aligning with larger networks. To remain viable, most physicians will need to share IT costs, reinsurance costs, contracting expertise, and clinical information, while maintaining some measure of independence. Many patients would prefer that too.

The payment reform initiative has a laudable but challenging goal – to make care more affordable while fostering quality and innovation. We haven’t been able to do it yet, but if anyone can do it, it’s this health care community in Massachusetts.

Let’s keep trying.

Dr. Young is a pediatrician based in Worcester, Mass.

Global Payments: How We Did It, and What Works (Third of 3)

Posted in Capitation, Global Payments, Payment Reform, Payment Reform Commission on January 8th, 2010 by MMS – Comments Off on Global Payments: How We Did It, and What Works (Third of 3)

This video is the last in a series of three videos by physician leaders in Massachusetts, who discuss how practices can succeed under a global payment system.

Earlier this week, Barbara Spivak, and Richard Lopez spoke about their practices’ experiences implementing and delivering care in a global payment framework. Today we hear from one of the largest physician networks in Massachusetts.

Speaker: Richard Parker, MD, Medical Director, Beth Israel Deaconess Physician Organization

Beth Israel Deaconess Physician Organization, with 1600 physician members in eastern Massachusetts, has extensive experience delivering care under capitated arrangements.

Key quote: “Health care in the U.S. is a great success and failure at the same time. The financial failure that’s busting the budgets of the entire economy cannot be allowed to go on the way it is, so doctors must recognize that change must happen.”

Among the issues he addresses:

  • Creating a culture that prepares a practice for global payments
  • Making a successful transition
  • Alleviating patients’ concerns
  • Whether global payments are the “right” answer for Massachusetts

Global Payments: How We Did It, and What Works (Second of 3)

Posted in Capitation, Global Payments, Payment Reform, Payment Reform Commission on January 6th, 2010 by MMS – Comments Off on Global Payments: How We Did It, and What Works (Second of 3)

This video is the second in a series of three videos by physician leaders in Massachusetts, who discuss how practices can succeed under a global payment system.

Earlier this week, Barbara Spivak, MD, spoke about the experiences at the Mount Auburn Cambridge IPA. Today we hear from one of the pioneers in this area.

Speaker: Richard Lopez, MD, Chief Physician Executive, Atrius Health

Atrius Health is the parent company for five practice groups in eastern Massachusetts, employing nearly 700 physicians. Its founding practice group, Harvard Community Health Plan, was one of the pioneers of a capitated payment system in the late 1960s.

Key quote: “You have to think about it as a journey. It’s going to take several steps to get there.”

Among the issues he addresses:

  • What physician groups need to be successful in a global payment system
  • The differences in delivering care in a global payment system
  • Whether global payments are the “right” answer for Massachusetts

Coming Friday: Richard Parker, MD, of the Beth Israel Deaconess Physician Organization.

Global Payments: How We Did It, and What Works (First of 3)

Posted in Capitation, Global Payments, Payment Reform, Payment Reform Commission on January 4th, 2010 by MMS – Comments Off on Global Payments: How We Did It, and What Works (First of 3)

This video is the first in a series of three video by physician leaders in Massachusetts, who discuss how practices can succeed under a global payment system.

Speaker: Barbara Spivak, MD,President, Mount Auburn-Cambridge IPA, Cambridge Mass.

The Mount Auburn Cambridge Independent Practice Association, with nearly 500 physician members, began operating under a form of global payments 10 years ago. Its physicians are on staff at Mount Auburn Hospital and the Cambridge Health Alliance (Cambridge Hospital and Somerville Hospital).

Key quote: “Focusing on quality helped get people to accept us in their offices more. … [Physicians] accept that we’re working for them, not for the health plans, and that we’re working for their patients.”

Among the issues she addresses:

  • How her practice started with global payments, what physicians learned
  • The patient’s  experience
  • Whether global payments are the “right answer” for Massachusetts

Coming Wednesday: Richard Lopez, MD, of Atrius Health