3 important events that can help us adopt new payment models

Robert M. Wah, MD , Former President

We’ve reached some important milestones on the road to better payment models in the last few months. As a physician, I always want to talk about delivery reform first, or at least simultaneously, with payment reform. We have seen what happens when we tweak the payment system and hope to force change in delivery—it leads to unexpected consequences.

While we physicians always are looking for better ways to care for our patients, actually doing so isn’t easy. We’ve come to expect obstacles to be thrown in our way. But right now, many factors are helping us on the journey to new care and payment models.

Last month, we released the results from a new AMA study conducted by the RAND Corporation that gave a look into how physicians are actually implementing new payment models. The study found that doctors are trying to make these moves but need help successfully managing the transition, including how to  respond to the many quality programs and metrics from payers to ensure long-term sustainability.

These findings will help the AMA change the environment for you and provide practical resources. We’ll use the results to guide the AMA’s work in improving alternative payment models and find ways to help physician practices make successful transitions to new models.

A few days after our AMA-RAND study release, we saw the launch of the U.S. Department of Health and Human Services’ Health Care Payment Learning and Action Network.

The network is a collaborative of payers, employers, physicians, patients, consumer groups and other partners within the health care community. Network participants will work together to capture best practices, disseminate information and apply lessons learned for supporting the increased adoption of value-based payment models. The idea is that all of these groups will transform our nation’s health system by working together.

I attended the network’s launch, where President Barack Obama outlined the importance of this network.

“We don’t need to reinvent the wheel—you’re already figuring what we need to do to reduce infections in hospitals or help patients with complicated needs,” he said. “What we have to do is share these best practices, these new ideas, including new ways to pay for care so that we’re rewarding quality. And that’s what this network is all about.”

We want to contribute to the success of this network. More than 2,800 groups from across the health care environment already registered to participate.

The most exciting recent development is the elimination of Medicare’s sustainable growth rate (SGR) formula. This failed budgetary gimmick created in 1997 has made Medicare unstable and unpredictable and prevented physicians from implementing innovative approaches to care—but we’re now in a new era.

Under the new law that eliminated the SGR, many of the competing quality-reporting programs in Medicare will be consolidated and better aligned. The risk of penalties also has been substantially reduced, and physicians now have potential for earning significant bonuses.

The law also provides monetary and technical support for those who choose to adopt new models of care suited to the 21st-century needs of physicians and their patients.

One of our main goals is to further lift physicians’ regulatory burdens and provide practical resources to advance professional satisfaction and practice sustainability. Now we can ramp up these efforts. Read more about how physicians’ worlds will be different in a post-SGR era.

So what’s next in the journey to innovative payment models? I wish I had a crystal ball, but I can’t say exactly how things will play out.

But I am confident that we physicians will continue to move ahead and adopt new models of payment and care delivery that make our patients healthier. I know we’ll be exploring innovative ideas and new ways to adapt and transform our practices.

I also know that the AMA will continue to work toward ensuring that physicians in all specialties, practice sizes and locations across the country can participate successfully in new payment and delivery models that allow them to better provide the best care to patients.

Tell me: What would make it easier for you to adopt new payment models? Tweet me @RobertWahMD and let me know.