How physicians are paid and evaluated can shape everything from where they practice to how they deliver care.
Three physician leaders shared the changes they would make, from simplifying reimbursement and addressing payment disparities to rewarding physicians for the value they create rather than the volume of care they provide.
Question: If you could change one thing about how physicians are compensated or evaluated, what would it be?
James Augustine, MD. Medical Director for Lee County EMS (Fort Myers, Fla.): Payment needs to be prompt and simple, based on simple to apply principles. The very complex system now requires providers and insurance companies to employ layers of workers, with resultant delays, downcodes, and denials. For emergency physicians, the addition of the No Surprises Act encourages bad behavior by insurers. That leads to layers of new personnel, attorneys and friction costs that are detrimental to the system and the patients.
Peter Bravos, MD. Chief Medical Officer of Sutter Health’s Surgery Center Division (Yuba City, Calif.): I’d fix the “33% problem.” Medicare reimburses anesthesia at roughly a third of commercial rates, while most other specialties collect 75% to 85% of theirs. Reimbursement for anesthesia sits on a separate, structurally lower scale that’s been eroding since RBRVS arrived in 1992. Facilities have papered over the gap with ever-larger stipends, but a subsidy is a symptom, not a solution. Stipends treat a broken federal payment formula as if it were each hospital and ASC’s private problem to fund, but that is not sustainable as Medicare’s share of the payer mix keeps growing. Every dollar of subsidy is a dollar the system is spending to work around a number it should simply fix. Correct the formula, and the stipend arms race takes care of itself.
Walter Allen Fink, DO. Associate Vice President and Chief Medical Officer UT Health San Antonio: I would move toward models that better reflect the value physicians create. To me, value is about delivering high-quality care and a great patient experience while being responsible stewards of our resources.
That means looking beyond how many patients someone sees or procedures they perform. We should also recognize whether care is safe, effective, timely, equitable, and patient-centered; whether physicians improve access and experience; and whether they help make the systems around them work better.
The key is making sure those measures are meaningful and are things physicians can actually influence. We do not need more metrics just for the sake of having more metrics. We need measures that help us deliver better care.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
