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Report: So Far, Revolution in Doctors’ Pay Hasn’t Really Changed Much

Authors find negligible difference in incomes at ACOs and more traditional practices

It was supposed to revolutionize U.S. health care: reward doctors who keep patients well with fewer tests, procedures, and appointments. Under the Patient Protection and Affordable Care Act, some doctors’ groups and hospitals have banded together in accountable care organizations (ACOs) to treat Medicare patients under this new philosophy. If the patient stays healthier with fewer appointments, the providers get a share of the cost savings.

But a new study has examined how doctors have been making money under the new system versus the status quo, and has found only negligible differences, according to an article in the Washington Post. The study appeared in the Annals of Family Medicine.

The researchers found inconsistencies in the way doctors are paid –– a combination of salary, money from providing services, and quality. The breakdown in pay for the 632 physician practices surveyed varied widely, regardless of whether the doctors worked in an ACO or in a more-traditional practice.

The authors also found that the amount of income tied to the quality of the care doctors delivered was small, even if they worked at an ACO that was trying to drive down costs by improving patient care. Physicians at ACOs had only slightly more of their incomes tied to quality –– 2% more than doctors in traditional practices.

Mark Friedberg, a senior scientist at the RAND Corporation, said that the new study confirms what other work has suggested –– that few organizations are passing on financial incentives to physicians. That’s because patient trajectories are “noisy,” Friedman said, meaning that any given patient could swing up and down from year to year, from needing lots of medical care to needing virtually nothing.

“You’re going to be penalizing and rewarding physicians almost entirely due to noise,” Friedberg said. His own research has suggested that, instead, physicians are given “soft” incentives, such as inserting quality measures into a job evaluation rather than tying them to pay.

But Friedberg said that part of the problem is that the doctors in these organizations don’t  see only Medicare patients –– they also take care of people whose insurance reimbursements follow a more traditional structure, which makes it difficult for changes in one payment model to have wide-ranging effects in how care is delivered.

That, combined with the study’s broader finding –– that there is variability in how primary care doctors are paid in the first place –– shows just how challenging it will be to change how medicine is practiced, Friedberg said.

Source: Washington Post; July 20, 2015.

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