While almost 80 percent of Maine physicians surveyed agreed that the current fee-for-service system should be restructured to align payment with optimal clinical care, only 50 percent indicated they are preparing for payment reform measures, such as accountable care organizations.
This was just one result of a survey of physicians on payment reform. The Maine Health Access Foundation (MeHAF) recently funded the survey, which was conducted by the Maine Medical Association (on behalf of the Maine Medical Education Trust) as part of a grants program focused on both payment reform and delivery system redesign. MeHAF awarded three rounds of grants with a goal of catalyzing and linking payment reform efforts in the state. Maine Medical Education Trust received a grant in the third round of funding, which emphasized efforts that would reach parts of the health care system that were not yet fully engaged in payment reform.
Maine physicians, especially those who still own their own practices, have many concerns about the implications of payment reform. This grant provided an opportunity to give voice to those concerns and to provide relevant educational resources to physicians through the Maine Medical Association, a highly trusted source.
The survey, which was a convenience sample of 293 respondents (13 percent of Maine Medical Association members polled), represents a diverse cross-section of Maine physicians in terms of age, practice size, specialty, ownership model, and geographic location. The many verbatim comments that are captured in the analysis provide a glimpse into the range of physician reactions to payment reform. While some doctors are actively educating themselves on payment reform, others are simply waiting for it to go away, as has happened in the past with managed care and other earlier efforts to control costs.
When asked how they were preparing themselves for payment reform, physicians answered:
“Adjusting to lower income and increased practice expense; adjusting to loss of professional satisfaction; accepting new interference in rendering appropriate care.”
“Dropped out of private practice; now work for health system.”
“Carefully—population by population.”
“Cautiously….waiting to see what other practices do.”
Seventy-seven percent of respondents believed that payment reform policies are being enacted without sufficient input from health care providers, while only 16 percent agreed that the measures on which payment reform is based are reliable and meaningful. Seventy-one percent of those surveyed were concerned that payment reform efforts create administrative burdens that distract from patient care.
Comments also reflected the importance to some physicians of addressing patient engagement in conjunction with payment reform and delivery system redesign. Their concerns highlight the need to foster better communication between physicians and patients. When those who indicated they were not preparing for payment reform were asked why not, answers included:
“…because payment reform has come and gone many times, each time with no improvement in the system and no significant effect on my practice patterns. Corporate interests are too entrenched and too powerful, and will never allow for meaningful change. My approach to practice has always been to do what’s best for patients despite the system’s perverse incentives and roadblocks to care. I doubt those will ever change meaningfully in American healthcare. We are a market-based system, and market-based systems will never provide efficient and appropriate care for all patients, no matter how you tweak the details.”
“My impression is that this is still something of a moving target. Waiting to see how this evolves, at least on a local level with our regional healthcare organization.”
“Physicians will be taking responsibility for the actions of patients that they have no control over. If the patients are not compliant and the physician continues to keep them in their patient panel then the physician will take the hit for the patient’s action or inaction. As I see it, payment reform will ultimately result in less payment to physicians. Physicians will be forced to dismiss certain patients from their practices in order to prevent this reduction in payment. The bar will be raised higher and higher each year and fewer and fewer patients will be able to meet the new standards. Many patients will have insurance and be unable to find a physician that will accept them because they are non-compliant….”
“I feel like payment reform is being thrust on us largely against our will and often without much input, especially by small practices/independent physicians. This is a costly endeavor with unclear outcomes. I am skeptical about the expected advances in quality of care and cost savings. All I see right now is a lot of extra work.”
Taken together, the results of this survey provide a road map to the challenges ahead in obtaining broad physician support for and participation in payment reform. Many physicians express a high degree of skepticism, citing earlier reform efforts that have come and gone without significantly changing the system. Some have chosen to retire rather than to engage with payment reform. Others have left private practice.
Though this survey reflects the voices of physicians in Maine, payment reform advocates across the country should be aware of the concerns that these physicians expressed in this survey and address them to effectively engage those physicians waiting at the periphery of ongoing efforts to realize meaningful payment and delivery system redesign.
Maine Medical Association Resources:
Read more about the survey here: https://www.mainemed.com/sites/default/files/content/Final%20Memo%20-%20Final%20Version%20-%20Payment%20Reform_0.pdf
Payment Reform Readiness: A Legal Toolkit for Physicians, Maine Medical Association, October 2013. The Maine Health Access Foundation funded the toolkit.
Payment Reform Resources for physicians (webpage).
Editor’s Notes: Related Reading:
“The Payment Reform Landscape: Overview,” by Suzanne Delbanco of Catalyst for Payment Reform, Health Affairs Blog, February 6, 2014.
“Payment Reform 101,” by Reem Aly, Health Policy Institute of Ohio, September 16, 2013 (slides).
