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Docs skeptical of value-based care

The new delivery model seems a doctor's dream come true, but physicians are leery

Doctors are told that the value-based care model will allow them to foster closer relationships with their patients, have greater access to clinical and pricing data and let them see fewer patients but earn more money. Value-based care sounds like a physician’s dream come true, but many are not enthusiastic about it.

“I think many physicians – probably most – are pretty hesitant about it – not because, in the theoretical world, they want to stay fee-for-service and they want to continue with the way things have always been,” said John Studebaker, a pediatrician who is also the chief medical information officer at population health management company Forward Health Group. “It’s that the potential for misuse – for being beaten up with data that doesn’t agree with what physicians know to be reality seems to be a high risk.”

[See also: Value-based payments picking up steam]

Many physicians have had the experience, he said, of receiving production reports from insurance companies or their employers and finding that the reports are inaccurate. He’s received reports from his insurance company connecting him to his wife’s patients, for example. “‘I think the data you’re giving me is wrong,’” he told his insurance company, and the response was, “‘No, it’s not wrong.’ Well, you know I’m a pediatrician and you’re giving me information on patients that are over 65. I think it’s pretty clear to me that these aren’t my patients that you’re sending me information on.’ The response was ‘Well, we still think you’re wrong.’ And that’s the environment that physicians have been in for 15 to 20 years,” Studebaker said.

“I don’t think there’s a whole lot of trust that this is going to be done well.”

Trust is really at the heart of the matter. It goes back to the 1990s, when managed care was touted as the model that would change healthcare for the better.

Physicians took personal financial risks for the managed care model and many got burned when the model collapsed, said Tom Doerr, a primary care physician practicing geriatric medicine in St. Louis who co-founded Lumeris, an accountable care solutions company.

[See also: Providers tepid on bundles]

Now, with the Affordable Care Act pushing the healthcare industry from volume-based care to value-based care, physicians who lived through the managed care era, in particular, are skeptical.

“I think older doctors have that taste in their mouths of ‘OK. We’re going to be put at risk. It’s going to be underfunded. We don’t really trust payers,’” Doerr said. “It’s got to be a different model. It’s got to be one where there is appropriate funding and where the payer is a genuine partner.”

Getting physicians to embrace the value-based care model is going to take time, said Michael Cassatly, an oral and maxillofacial surgeon who left practice to start MedAchieve, a professional coaching company serving the healthcare industry.

As doctors begin to see other doctors experiencing the benefits of value-based care – greater trust between themselves and their patients, access to credible data, earning more but seeing fewer patients – they’ll come around, he said.

“They’re going to be happier in their careers not only because they’ll be making more money, but it kind of brings them back to the basics of why they went into medicine –which was to connect with people and to help people have a better quality of life.”


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