While the shift from volume- to value-based payment models will reward primary care physicians for work they weren't paid for in the past, such as monitoring patients between appointments, specialists will find new compensation models most difficult, according to a Bloomberg report.
Specialists find the move toward value-based pay most challenging because their compensation is largely based on the number of services they perform, which could prove problematic for patients as well. Oncologist Jeffrey Ward, MD, told Bloomberg he worries the shift will discourage oncologists from providing treatments like chemotherapy, one of the most expensive cancer services.
Last week, HHS Secretary Sylvia Mathews Burwell announced the government's timeline to end Medicare's fee-for-service payments, which includes at least 30 percent of fee-for-service payments moved into new value- and quality-based programs by 2017, and 50 percent by 2019, according to the report.
Physicians contend that this shift will put additional pressure on specialists who have been considering consolidation with local hospitals, merging practices or leaving medicine altogether, and these issues are particularly heightened in rural regions where specializing physicians are fewer, the report says.
To sustain viability during the reimbursement model shift, oncologists and other specialists have embraced consolidation to secure market share and improve their ability to negotiate with insurers. Bloomberg cites Nashville-based Tennessee Oncology, a group that has grown from three physicians in 1992 to 85 today, as one example of such consolidation.
According to the report, CMS plans to start with oncologists on figuring out new ways to pay specialists. Many oncologists anticipate this will come in the form of bundled payments.