Global Payments: Ready. Or Not?

As Massachusetts moves quickly toward a new system of paying for health care, a key question that remains is this:  Are physicians ready for global payments?

It’s a critical one for doctors, because within such contracts, they bear the clinical responsibility for and the financial risk associated with managing the medical care of their patients.

To get some answers, the MMS surveyed both primary care and specialty physicians last year on their preparedness for global payment contracts.  The final report on the study has just been issued.

The study had three goals: (1) to find out the current range of payment structures among physicians; (2) to understand their perceptions and attitudes toward global payments; and (3) to assess their perception of their readiness to enter into such contracts.

Survey respondents included 572 physicians, 290 who work in solo or small single-specialty practices, and 282 who work in larger, multi-specialty groups or groups connected to hospitals.  Here are some of the principal findings:

  • While 67 percent of respondents reported having access to computer systems for managing some types of clinical information, only 7 percent said they had computer-based systems that permit clinical information exchange, communication, and management both inside their group and with physicians and hospitals outside of their group.
  • Only 29 percent reported that their group is ready to enter global payments contracts, and only 21 percent said their group is both ready to enter such contracts and large enough to provide comprehensive care , negotiate with health plans, and attract skilled managers to oversee these processes.
  • Those practicing in large groups with experience with financial performance incentives were more likely to say they were ready for global payments.
  • Physicians also questioned the presumed benefits of global payments:  Only 44 percent believe that medical spending will decrease with global payments, only 19 percent think quality will improve, and 76 percent think that a global payment system will reduce the number of physicians willing to work in Massachusetts.

One important conclusion the authors draw from this study is this:  physicians report “having few or limited structures that could support population management of medical care,  such as electronic clinical information exchange systems across providers.”

Simply stated, while much attention, energy, and money are now being devoted to health information technology from many sources, physicians say there still isn’t enough information technology infrastructure to accommodate the change at this time.  The authors did note, however, that the survey responses varied considerably by practice size, geography, and specialty.

The complete report, The Massachusetts Medical Society’s Physician Survey on Global Payments, is available on the MMS website.

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