WASHINGTON (FRONTLINE MEDICAL NEWS) – If doctors want to improve their reimbursement and at the same time be a catalyst for reducing costs to the overall health care delivery system, they need to be stronger advocates for themselves.
This was the message of Harold D. Miller, president and CEO of the Center for Healthcare Quality and Payment Reform, in his presentation to the American Gastroenterological Association Partners in Value meeting on Oct. 6.
“I think the problem is that we are developing [payment models] in entirely the wrong way today,” Mr. Miller said. “We are doing the top-down approach, which is where Medicare and the health plans are defining the payment system. Then physicians and hospitals have to figure out how to change care to respond to that and guess who ends up with the short end of the stick? It’s the patients and the physicians.”
He called specifically on doctors to exercise initiative and accept the accountability that comes with leading the charge for payment reform.
“I think there is a much better way, which is bottom up, which is to say ask the physicians and the hospitals to say what are the ways you can improve care and reduce costs,” he continued. “Then get payers to provide adequate support for that but have physicians take accountability for actually achieving those results they think are possible. And then you have patients who get good care and you keep physicians and hospitals financially sustainable, which nobody in Washington is talking about how to actually do.”
Getting to that point is going to require physicians to be much more proactive in who they communicate with to get the information that is necessary to build payment models from the bottom up.
“I think there are lots of potential solutions, but I think it needs to be talked about,” Mr. Miller said. “If I were to leave you with one message, the problem is that employers, Congress, etc., are not hearing from physicians that you want to do something different.”
He noted that part of the issue is the adversarial relationship doctors have with the payer community, noting that most “health plans demonize you all.”
Mr. Miller added: “They go in to employers and they tell employers that the only thing standing between the employers and certain health insurance bankruptcy is the health plan because all the doctors want to do is spend more money.”
To change that, it is going to require doctors to be much more proactive in reaching out past the payer middleman to start engaging directly with employers.
“Employers do not see doctors as their partners,” Mr. Miller noted. “The people who pay have to start seeing you as wanting to solve the same problem they are trying to solve.”
And working with employers could help physicians insofar as getting access to data that would be crucial in developing the kinds of payment models that would benefit all of the financial aspects of health care delivery while at the same time improving care.
Mr. Miller recounted how various state and local governments in Maine were trying to extract clinical information that might not be ascertained from claims data from Anthem, the largest or second largest health insurance company in America. Initially, Anthem balked, prompting the state and local entities to issue requests for information and seek to replace Anthem as the main provider for its health insurance coverage.
“Anthem completely changed its attitude,” he said. “All of a sudden, Anthem was back in. … Anthem felt that impact all the way in Indianapolis. Sam Nussbaum, MD [former chief medical officer at Anthem], said to me, ‘We were punished in Maine.’ ”
He noted that some big employers are seeking out direct contracts with health systems because they are not getting support from the health plans.
“But they need to hear from you and what it is you need and what you are going to do with it,” he said. “It is not just give us data, see ya. It is here’s what we are trying to do. Here is the information we need and why we need it. If you say to an employer ‘I want to know how many patients are being hospitalized so that I can help you reduce hospitalizations,’ do you think they are going to say nah, we are too busy for that?”
