Specialists Oppose Reimbursement Reforms That Reduce Their Pay http://tinyurl.com/269qjjk October 25, 2010 — Physicians generally agree that the Medicare rates they receive are flawed, but they differ on how to make things right, with specialists opposing reforms that trim their paycheck, according to a study published today in the Archives of Internal Medicine. Of all physicians who responded to the survey (n = 1222), 82% said they accept Medicare, and 78.4% concurred with the statement that some procedures are overcompensated under the federal program, whereas others are compensated at rates that do not cover costs. This level of agreement varied little across physician specialties, according to study author Alex Federman, MD, MPH, associate professor of medicine and general internal medicine at Mount Sinai School of Medicine in New York City, and colleagues, who surveyed physicians in the summer of 2009. This strong consensus broke down when it came to reducing payments for procedures so that rates could be raised for management and counseling services, a formula tilted toward primary care. Only 41.6% of physicians endorsed this approach. Although the idea proved popular with primary care physicians (66.5%), and to a lesser extent with medical subspecialists (54%), it had little traction with surgeons (16.6%) and other specialists (27.3%). To be sure, 79.8% of physicians said that their primary care colleagues needed a raise, and specialists were almost as likely to espouse that view as family physicians, general internists, and pediatricians (another study in the same issue of the journal found that specialist pretax hourly income was 36% - 48% higher than that for primary care physicians). However, backing for a primary care raise declined to 21.7% among surgeons and 36.7% among medical specialists when it meant cutting specialty reimbursement by 3% in the process. Democratic members of Congress who drafted the healthcare reform law called the Affordable Care Act (ACA) factored in this specialist antipathy toward a sacrificial pay cut, noted Paul Ginsburg, PhD, president of the Center for Studying Health System Changes. Several provisions of the ACA, said Dr. Ginsburg, boost reimbursement for primary care physicians with "new" money, as opposed to money taken away from specialists. "There's a Lot of Understandable Skepticism" The authors of the Archives of Internal Medicine study surveyed physicians before the specific reforms of the ACA were spelled out, but their questions pertain to the overall thrust of the legislation. For example, the law authorizes pilot projects to test reimbursement models that reward physicians for the quality of their care — think pay-for-performance. Just 49.1% of all physicians in the study favored the use of such financial incentives, with the level of support largely the same from specialty to specialty. A less-than-robust appetite for quality-of-care "carrots" does not surprise Dr. Ginsburg. "There's a lot of understandable skepticism," Dr. Ginsburg told Medscape Medical News. Physicians worry that bonuses for better performers will be funded by lowering pay for other clinicians, he said. "People fear it could be a zero-sum game." Physicians were even less enamored with the idea of "bundling," another reimbursement method that will be tested under ACA. In bundling, multiple providers — say a hospital and a group of physicians — would share a single fee for treating and managing a single episode of patient care, such as orthopaedic surgery. The authors of the Archives of Internal Medicine study found that 69.1% of physicians opposed payment bundling. Weak physician buy-in for various payment proposals likely reflect the sketchy nature of these proposals, which are still in the experimental stage, said Dr. Ginsburg. "I'd be surprised if you'd see a lot of enthusiasm about them," he said. He added that because the exact future of physician reimbursement is still unknown, some of the questions posed in the Archives of Internal Medicine study are premature. "It's counterproductive to ask people about something they don't understand because it's not developed yet," said Dr. Ginsburg. The authors received grant support from the Robert Wood Johnson Foundation; the National Institute on Aging; the National Heart, Lung, and Blood Institute; and the Veterans Administration Health Services Research and Development Service. Arch Intern Med. 2010;170:1735-1742. --------------------------------------------------- 人家国外这样做 我们呢？ --

※ 发信站: 批踢踢实业坊(ptt.cc) ◆ From: 210.60.122.3