Report Seeks to End Physician Fee-For-Service

  A recent report released by the National Commission on Physician Payment Reform calls for the elimination of fee-for-service payments to physicians by the end of this decade, according to MedPage Today. The commission was convened by the Society of General Internal Medicine in March 2012.   The report, published March 4, suggests replacing standalone fee-for-service with a blended payment system based on new delivery and reimbursement models. A number of recommendations to change the way doctors are paid and discourage incentives that may lead to higher cost as well as higher volumes of care were outlined.   “The commission concluded that our nation cannot control runaway medical spending without fundamentally changing how physicians are paid, including the inherent incentives built into the current fee-for-service pay system,” reads the 24-page report. Among the listed considerations:     • Including evaluation and management diagnostic codes, which are currently undervalued, in annual updates     • Eliminating higher payments for facility-based services that can be performed in a lower-cost setting     • Incorporating quality metrics into negotiated reimbursement rates of fee-for-service contracts     • Forming virtual relationships between small practices to share resources     • Including fixed payments where significant potential for cost savings exists, such as care for people living with multiple chronic conditions and in-hospital procedures and their follow-up     • Ensuring access to high-quality care and physician commitment for fixed payment models.   The report also named several factors that are driving healthcare costs, including reliance on technology and expensive care; high ratio of specialists to primary care physicians; and paying more for the same service when done in a hospital rather than outpatient setting. The commission also calls for eliminating Medicare’s sustainable growth rate (SGR) formula and suggests that an SGR repeal to be paid for with cost savings from the Medicare program, including physician payments and reductions in inappropriately used services. The commission’s work was reportedly funded by the Robert Wood Johnson Foundation and the California HealthCare Foundation.