As public and private payers push forward with experiments and payment reforms, hospital and health network officials have the unenviable task of trying to persuade physicians that the new reimbursement models are in everyone's best interest.
A recent survey by the Medical Group Management Association found that about 82 percent of physician practices are willing to try a new payment and delivery model, such as bundling, but a lack of predictability and financial risks were listed as some of the biggest barriers to keeping doctors from making the leap. Physicians sometimes are wary when an entire payment goes straight to a hospital, forcing them to trust that the hospital will split it fairly, says Anders Gilberg, senior vice president of government affairs for the MGMA.
"As interesting as it is in theory, it does inject a potential for political issues among providers and physicians," he says. "We constantly hear concerns from physicians that money may go to the hospital and then they would be at a disadvantage in terms of negotiating with them on that bundle."
Building trust is critical if hospitals want physicians to join a bundled-payment initiative, says Robert Minkin, senior vice president of the Camden Group and former CEO of Exempla Saint Joseph Hospital in Denver, which took part in a Medicare bundled-payment demonstration between 2009 and 2012. Ways to do so include co-managing the program with doctors, establishing incentives that share any potential savings, and promising that base compensation for an episode will remain the same under the new model, Minkin says.
"It's an easier conversation to have with them because you're not asking them to take a reduction out of the gate," he says.
Hospitals should present bundled payment — with both Medicare and commercial payers — to doctors as a first step toward physician-hospital integration. Take it service line by service line, Minkin says and, after a few years, physicians may be ready to take on broader levels of population health risk.
Physician groups sometimes are hesitant to try bundling if the scope of the program is too narrow in focus, says John Schmitt, managing director of Reliance Consulting Group in Atlanta. He's advising a handful of orthopedic practices that are exploring potential arrangements with a commercial payer. Why, for example, would such a bundle include just hip and knee replacements and exclude the practice's spine doctors? The pilot might not be enticing to groups, he says, if it only covers a small percentage of their business.
Schmitt also stressed the importance of transparency on the part of the hospital, as well as a willingness to shield doctors from potential risk. Breaking the ice will be hard, but he thinks such new payment arrangements are the way of the future.
"I've met with a number of medical groups in the last few months, and they're all pretty skeptical. I'd say that's the mood out there," Schmitt says. "Everybody knows that the current fee-for-service system is not sustainable, but this is going to be a bit of a slog for a while."