How Much Pay for How Much Performance?
A new commentary from National Pharmaceutical Council Chief Science Officer Robert W. Dubois, MD, PhD, looks at some potential repercussions of the shift from a fee-for-service provider compensation model toward a system of compensation on the outcome of services delivered, not the quantity. Many new structural and payment models are emerging in response to this shift, including Accountable Care Organizations (ACOs) that are working within the Medicare Shared Savings Program (MSSP) to deliver start-to-finish care for large populations.
A new commentary from National Pharmaceutical Council Chief Science Officer Robert W. Dubois, MD, PhD, looks at some potential repercussions of the shift from a fee-for-service provider compensation model toward a system of compensation on the outcome of services delivered, not the quantity. Many new structural and payment models are emerging in response to this shift, including Accountable Care Organizations (ACOs) that are working within the Medicare Shared Savings Program (MSSP) to deliver start-to-finish care for large populations.
Either compensation system generates particular incentives: in a fee-for-service environment, providers benefit from delivering a larger volume of services—which, if taken to extremes, leads to a situation described as “overuse.” In a “bundled payment,” or fee-for-service-package, environment, there may be financial benefit in delivering fewer services—a scenario described in its extremes as “underuse.”
Both scenarios risk missing the opportunity to deliver the level of care that best serves patients. Dr. Dubois, in his commentary published in the Journal of Comparative Effectiveness Research (JCER), assesses the checks and balances available to ensure the evolved health care system yields positive patient outcomes.
One word binds all the system moderation options together: quality. A plethora of different quality measures and physician reimbursement ratios for quality achievement exist; the National Quality Forum alone has approved more than 600.
Yet despite the overwhelming range of models, the crucial element missing from the current menu of quality assurance measures is evidence of what works best in the current environment. Dr. Dubois found there is too little high-quality research into the most effective rates of compensation for physicians to provide efficient, high-quality care. Quality bonuses and/or penalties below 5% likely aren’t enough to balance financial incentives to skimp on care; rigorous, randomized studies are needed to help calibrate compensation to the right level. Until this “sweet spot” is found, a key question remains unanswered: how much pay for how much performance?