Doctors mostly agree that there is something inequitable about Medicare’s current reimbursement system – the consensus goes across the whole country – however, their opinions on how it should be reformed vary considerably and the likelihood of any agreement at this moment appears distant, researchers wrote in the peer-reviewed journal Archives of Internal Medicine.
The authors explain as background information:
Across the political spectrum, there is general agreement that the cost of health care has risen to untenable levels and is threatening the future of Medicare and the economic well-being of the United States.
Approximately one-fifth of health care costs go towards doctors. However, because of the nature of their work, they trigger other expenses. Hence, a considerable number of reform suggestions are aimed at clinician reimbursement as a way of saving money and improving care.
Some reformers have proposed financial bonuses for attaining quality standards, as well a system of fines for providing poor quality care, grouping episodes of care into fixed payments, and making care organizations more accountable.
Alex D. Federman, M.D., M.P.H., of Mount Sinai School of Medicine, New York, and team carried out a survey of doctors nationwide between June 25 and October 31 2009 – the physicians were randomly selected. They were asked:
- Under Medicare’s current reimbursement system are some procedures reimbursed too highly?
- Under the current system, are some reimbursements for procedures too low to cover costs?
- They were also offered various reform proposals and asked to rate them
1,222 (48.5%) out of 2,518 doctors responded to the survey. 78.4% of them agreed that Medicare’s current reimbursement system did not fairly represent costs of procedures. Regarding reform proposals, however, the authors wrote that “there was little unity regarding support for physician payment reform proposals.”
49.1% of doctors agreed there should be financial incentives for quality care – the proposed reform with greatest consensus.
The researchers wrote:
Actual experience with financial incentives to improve quality could have directly informed physicians’ generally more positive views of these types of reimbursement mechanisms.
41.6% agreed that payments should be moved from procedures to management and counseling services, but agreement varied widely between surgeons (16.6%) and generalists (66.5%). The authors added:
As expected, those who conduct procedures were against it, and those who do more management and counseling were for it.
Highlighted below are some details on doctors’ opinions regarding reforms:
- 69% opposed bundling
- 15.2% of surgeons supported bundling
- 79.8% supported more pay for generalists
- Only 39.1% agreed to make up for this increase in pay for generalists with a 3% drop in specialist reimbursement
The authors concluded:
Overall, physicians seem to be opposed to reforms that risk lowering their incomes. Thus, finding common ground among different specialties to reform physician reimbursement, reduce health care spending and improve health care quality will be difficult. Research that clarifies the tradeoffs physicians would be willing to accept in payment reform, and other concerns, may help refine the design of payment reforms and improve acceptance among physicians.
Arch Intern Med. 2010;170(19):1735-1742. doi:10.1001/archinternmed.2010.369
Written by Christian Nordqvist