Recently we wrote a blog post promoting the benefits of shifting from fee-for-service to value-based payments. We praised the recent decision by leaders at the U.S. Department of Health and Human Services (HHS) to accelerate that shift, and we were then and remain convinced this shift paves the way for better, more affordable care.
There were some strong reactions to the post.
Some people think capitated payments have been discredited, others believe the change from fee-for-service will change little. One physician told John Irvine, editor at The Health Care Blog, that he got the impression from our post that we were saying value-based payments would make physicians lives easier. “Really?” Irvine’s doctor friend said. “You’re making my life easier? Prove it.”
How Will the Practice of Medicine Change?
We didn’t actually use the word easier in the post though we did say that “increasingly, physicians seek liberation from the constraints of fee-for-service in order to focus on the overall health of their patients. Value-based payments allow doctors to do exactly that.” So we definitely hear what Irvine’s friend is saying — and we understand his frustration. Has there ever been a time when so many physicians have been worn thin — angry with the direction of our health care system?
Irvine invited us to respond to his friend and we thought we would do so by soliciting the thoughts of Scott Young, MD, executive director of Kaiser Permanente’s Care Management Institute and associate executive director for Clinical Care and Innovation at The Permanente Federation.
“Easier?” said Dr. Young. “No, value-based payments don’t make doctors’ lives easier. But I think it does make the practice of medicine more rewarding and fulfilling.”
“At Kaiser Permanente,” he said, “we work in teams where we make every effort to fully maximize the capabilities of all our team members. And our doctors are salaried so we do not create unintended incentives. In our prepaid system people aren’t constantly worrying about this goal or that goal being at odds with the best patient care.
“Our doctors are unencumbered by external administrative oversight. They’re not worrying about coding, nor worrying what the relative value unit (RVU) count is going to be for this month.
“When you think about fee-for-service that is exactly what it is – you get paid a fee for a particular service whether that service worked, didn’t work, was indicated or not indicated. At Kaiser Permanente we are paid to take care of the person. It is a very different ethos.
“The vast majority of Permanente doctors I talk to are happy. Our approach makes sense to them. We take care of members in teams based on the best evidence. Our doctors do not have to worry about something being approved by a health plan. They don’t have to worry about all the other ancillary stuff. They are guided by the idea: what is the right thing to do for our members and patients?”
No, value-based payments don’t make doctors’ lives easier. But I think it does make the practice of medicine more rewarding and fulfilling.
– Scott Young, MD
At Kaiser Permanente, we are aligned with the accelerating trend toward value-based payments. This evolution is fueled most recently by the HHS announcement and we applaud that. We welcome the opportunity to help spread payment innovation in alignment with the Learning Action Network recently established by HHS.
The transition from fee-for-service will not be easy or smooth but it is happening ever more rapidly. There will be bumps in the road — some major — but in the long run this evolution will help our country progress toward the Triple Aim while at the same time freeing doctors to focus more on the needs of patients than on administration.
Charles C. Kenney is a former reporter and editor at the Boston Globe and author of several books on healthcare in the United States.
Cochran and Kenney are authors of The Doctor Crisis: How Physicians Can, and Must, Lead the Way to Better Health Care. Both write about physician leadership at kp.org/physicianleader, where this post originally appeared.