The overwhelming majority of physicians and specialists employed in group practices owned by health systems are still paid based on the volume of care they provide, despite industry efforts to move toward value-driven payments.
Researchers from the RAND Corporation, a nonprofit research group, and Harvard Medical School analyzed payment structures used across 31 physicians organizations affiliated with 22 health systems for their study, published Jan. 28 in JAMA Health Forum.
More than 80% of primary care physicians and 90% of specialists received base pay under volume-based models. On the flip side, only 9% of PCPs and 5% of specialists said their compensation was based entirely on quality and cost performance measures. Most arrangements did include value-driven incentives but pay is still dominated by volume, experts explained Friday.
“Despite growth in value-based programs and the need to improve value in healthcare, physician compensation arrangements in health systems do not currently emphasize value,” lead author Rachel O. Reid, a physician policy researcher at RAND, said in a statement. “The payment systems that are most often in place are designed to maximize health system revenue by incentivizing providers within the system to deliver more services.”
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The cross-sectional analysis included interviews with 40 U.S. health system–affiliated physician organizations, survey responses and other compensation data gathered between June 2019 and September 2020.
Performance-based incentives for achieving value-driven goals—clinical quality, cost, patient experience and access—were often included in doctors’ compensation plans but accounted for a small proportion of overall pay that was unlikely to influence physician habits, the authors noted.
Doctors looking to take home more money were better off increasing the volume of services they delivered, which was cited by 70% of practices as the top action to increase compensation.
“For the U.S. healthcare system to truly realize the potential of value-based payment reform and deliver better value for patients, health systems and provider organizations will likely need to evolve the way that frontline physicians are paid to better align with value,” Reid said.
You can read the entire study here.