Frontiers of Health Services Management - Summer 2013 - (Page 32)

to move forward in the MSSP despite the limited likelihood of sharing in savings, because we believe that our participation promotes a continuous learning culture and creates greater value for patients. attribution, although now much improved from the PgP Demonstration, remains problematic, and the data we have received show that over an 18-month tracking period, only 60 percent of our originally attributed beneficiaries remain in our patient group. Management difficulties arise with the attribution methodology when that many patients exit and new ones enter. Patient notification Both culture and requirements are probleadership are critical to lematic, as is cMS’s slow the development of future turnaround of information. Despite our many models of healthcare concerns, we believe that delivery. acos point in the right direction, even if, as suggested by leaver, they may be transitional. as goldsmith and christensen and his colleagues observe, the savings may be relatively modest, strongly influenced by documentation and risk adjustment, and show more potential in highly inefficient and costly markets. PHc and UnityPoint Health may find Medicare advantage and commercial aco partnerships more promising. in addition, bundling payments for improved care, patient-centered medical home payment models, and payment models focusing on high-risk and high-cost populations may have more sustainable success. Fee-for-Service Transition Both PHc and UnityPoint Health address the difficulty of living in the fee-for-service and new payment worlds at the same time. PHc views this as being in curve a while trying to prepare for and move to a new curve B. one astute observer, Paul ginsburg (2012) of the center for Studying Health System change, contends that physicians’ pay, even in the new payment models, will be based on a flawed fee-for-service system. even with some changes in recent years, glaring differences remain between the reimbursement of primary care physicians and that of some specialty and surgical physicians. He argues strenuously that modernization of the physician fee-for-service system should remain a high priority. Some, including myself, believe that recommendations to reemphasize the same fee-for-service physician payments in all sites (i.e., elimination of hospital-based physician reimbursement) at levels we believe are below cost go in the wrong direction and will drive physicians to further increase volume in their owned facilities or to seek hospital or other employment in organizations that will then have their own cost-related volume strategies (MedPac 2012). a much better approach would be to enforce appropriate criteria for the receipt of these payments so that physicians and their organizations are motivated to demonstrate true integration, system approaches to coordination of care across silos and over time, and improved value. the importance of reforming the current payment system extends to hospitals, where some services have large margins and others have large losses. Such disparity can lead to driving major strategic and investment decisions that are not always in the best interest of coordinated patient care, particularly those for patients with multiple complicated disorders. ginsburg’s argument, in my view, is a good one and applies to current physician and hospital payment policies. the impact of 32 • f ro ntier s o f h ea lth s e rvic e s m a na g e me nt 29 :4

Table of Contents for the Digital Edition of Frontiers of Health Services Management - Summer 2013

Frontiers of Health Services Management - Summer 2013
Contents
Editorial
At the Heart of Integration: Aligning Physicians and Administrators to Create New Value
Volume to Value
Physician-Led Models of Accountability and Value: Observations on Payment Policy and Culture
Collaboration Across Clinical Silos
Breaking Down Clinical Silos in Healthcare

Frontiers of Health Services Management - Summer 2013