Only 10.9 percent of payments to doctors and hospitals in the commercial sector in 2013 are linked to their performance or designed to cut waste, according to the National Scorecard on Payment Reform released Tuesday by the Catalyst for Payment Reform (CPR), a non-profit group of employers and large healthcare purchasers that advocates for paying for value.
The scorecard is designed to track the nation's progress as it moves from fee-for-service payments based on volume to those oriented toward value, including bundled and global payments and is funded by the Commonwealth Fund and the California HealthCare Foundation.
CPR's employer participants, including GE, Boeing and Wal-Mart, and large public purchasers like CalPERS and TennCare, have set a goal that 20 percent of commercial payment would be value-oriented by 2020.
The National Scorecard on Payment Reform uses data submitted on a voluntary, self-reported basis to eValue8, the National Business Coalition on Health's annual request for information to health plans. The plans responding to the CPR scorecard questions represent almost half of the commercially-insured lives in the U.S.
Of the 11 percent of payments that are value-oriented, 43 percent of those payments give providers financial incentives without risk by offering a potential bonus or added payment to support higher quality care, such as fee-for-service with shared savings, according to a CPR news release. The other 57 percent of payments put providers at financial risk for their performance if they do not meet certain quality and cost goals, such as in a bundled payment.
Overall, 89.1 percent of payments, or nearly $9 out of $10, remain traditionally fee-for-service, paying providers for every test and procedure they perform regardless of necessity or outcome, or in bundled, capitated, or partially-capitated payments without quality incentives, CPR noted in the release.
"We know traditional fee-for-service payment creates incentives for waste and inappropriate care," said Suzanne Delbanco, CPR's executive director, in the announcement.
Additionally, the scorecard showed that just 11 percent of all hospital payments and 6 percent of all outpatient specialist and primary care physician payments are value-oriented. Of the total outpatient payments made, about 75 percent go to specialists and 25 percent go to primary care physicians, according to the scorecard.
"Now that we have a sense of where things stand, we can hold ourselves and the health plans and providers with whom we partner accountable for accelerating payment reform," said Steve Morgenstern, North America health and welfare plans leader for the Dow Chemical Co., in the announcement.
Along with the scorecard results, CPR also unveiled the National Compendium on Payment Reform, a web-based, searchable and sortable database of the various payment reform programs underway across the country. Providers and plans can add their payment reform efforts to the database, which will grow over time.