Shifting reimbursement models: The risks and rewards for primary care

  The Affordable Care Act (ACA) places primary care physicians (PCPs) front and center in the mission to improve the health of Americans, and lower overall healthcare costs. But new ACA-derived payment models that reward value, not volume, are driving skepticism and uncertainty among physicians. Nine out of 10 physicians cited shifting reimbursement models and the financial management of practices as their top challenges, according to a 2013 Wolters Kluwer Health survey.

In the next two to five years, the shift from fee-for-service (FFS) to value-based reimbursement will be even more dramatic. The trend adds even greater urgency for physicians to better understand payment reform and plan to adapt, says Deborah Walker Keegan, PhD, FACMPE, president of the Asheville, North Carolina-based consulting firm Medical Practice Dimensions, Inc.

“This is really a tough time because physicians still need high productivity, but they also need to start measuring value,” she says. “The levers haven’t really switched from productivity to quality and value, but you don’t want to have a learning curve that is so steep you can’t deal with it when the switch gets flipped.”

Reform, however, doesn’t mean physicians will be paid less, counters Reid Blackwelder, MD, FAAFP, president of the American Academy of Family Physicians. Cost savings to the system from better efficiency and reduced duplication of services should benefit physicians.
“All of the new models, including the ACOs [accountable care organizations], are about sharing risk and sharing savings,” he says. And that can increase payments, especially to PCPs.