Policy paper calls for system improvements that prioritize patients, simplify billing and documentation, support primary care, correct disparities and redesign health IT
Feb. 21, 2020 (ACP) – As an organization representing internists on the front line of American health care, the American College of Physicians is sending an urgent message to government leaders: The health care delivery and payment systems need an overhaul to improve care and lower costs.
ACP offers specifics in a report titled, “Envisioning a Better U.S. Health Care System for All: Health Care Delivery and Payment System Reforms,” one in a series of policy papers released in January 2020. The collection of papers, known as “Better Is Possible: The American College of Physicians Vision for the U.S. Health Care System,” was published in Annals of Internal Medicine.
“It's crucial for ACP to weigh in on the topic of health care and create a new vision,” said Dr. Ryan Mire, chair of ACP's Medical Practice and Quality Committee. “We believe the current U.S. health care system is overly complex and inefficient, leaves too many patients without coverage and is administratively burdensome and too expensive with an inadequate return on investment in regards to health outcomes. As primary care physicians, we are especially equipped to offer a way forward.”
The report underwent a robust review following a comprehensive analysis of the medical literature and input from numerous ACP committees and individual members. “We're proud of this extraordinary collaborative effort,” said Mire, one of the report's lead authors. “We've been able to comprehensively consolidate the messages of our advocacy efforts.”
On the payment front, the report says, “[P]ayment systems must be made to put the interests of patients first, better support primary care, make health care less complex, correct inappropriate disparities in payment levels between complex cognitive care relative to procedures, simplify billing and documentation requirements, and redesign health IT to transform VBP (value-based purchasing) programs to achieve what matters most to physicians and their patients.”
ACP offers these specific recommendations in the report:
- Value should always be defined with patients and families at the center, so they are active partners in all aspects of their care. “Evidence shows that patients who are active participants in their health care have better outcomes,” Mire said. “Setting goals together with the patient through shared decision-making is essential as each patient may have differing values, lifestyles, genetics and socioeconomic circumstances that affect their overall health experience and engagement.”
- Transparency is crucial. Patients, families, caregivers and their clinical care teams should be provided with transparent, understandable, actionable and evidence-based quality, cost and price information to meaningfully compare medical services, facilities and products.
- Health care delivery and payment should be redesigned to support physician-led, team-based care delivery models in providing effective patient- and family-centered care.
- There is no one-size-fits-all model to achieve reform of the delivery and payment systems. A variety of approaches should be considered and evaluated.
- Payers should prioritize inclusion of underserved patient populations in all value-based payment models. “The ACP strongly supports further research about care models that address the needs of underserved populations affected by social determinants of health and considers VBP reform models a critical vehicle for doing so,” the report says.
- All payment systems should increase relative and absolute payments for primary care commensurate with its value in achieving better outcomes and lower costs. Inappropriate disparities in payment levels between complex cognitive care and preventive services should be eliminated.
“Access to primary care is consistently associated with higher quality of care, lower mortality rates, higher patient satisfaction, and lower total health care costs to the system,” Mire said. “Increasing primary payment may also help reverse the growing shortage of primary care by increasing interest in the field.”
- Unnecessary, inefficient and ineffective billing and reporting requirements for all health care services should be eliminated. Administrative barriers to appropriately paying for and valuing care that is not face-to-face, such as care management, should be reduced. “Administrative burden is rated as the number one challenge that faces physicians and drives burnout,” Mire said. “For every hour a physician spends with a patient, they spend two hours on EMR (electronic medical records) and/or deskwork.”
- Value-based payment reform initiatives should increase flexibility and freedom from billing, reporting and other administrative burdens in exchange for holding physicians and clinical care teams accountable for quality and cost outcomes.
- Performance measures and measurement methodologies that are tied to public reporting and payment should be aligned across payers, models and programs whenever possible.
- Value-based payment programs should move away from “check-the-box” performance requirements toward a limited set of patient-centered, actionable, appropriately attributed and evidence-based measures for public reporting and payment purposes while also supporting the use of additional clinically meaningful measures for internal quality improvement.
- All performance targets should be provided to physicians and their clinical care teams prospectively and transparently. All performance feedback should be accurate, actionable and timely.
- Reform should include collaborative, multi-stakeholder measure development and a maintenance process with upfront, ongoing and transparent input from patients and frontline physicians and their clinical care teams.
- The performance measurement infrastructure should support and prioritize what is important to measure and should evaluate and continually improve the methodologies used for performance measurement.
- Improvements to health IT usability should prioritize the needs of patients and frontline physicians and their clinical care teams, strive to remove non-value-added interactions and support value-based payment reform initiatives.
- Interoperability efforts should focus on the adoption and consistent implementation of health IT standards irrespective of the health IT system or digital technology.
- Finally, reform of health IT standards and interoperability rules should happen in stages to allow adjustment and avoid adverse effects.
“Physicians must be involved throughout the entire heath IT development and testing process,” Mire said. “Interoperability should be more practical, so that the exchange of information includes content that is meaningful, succinct and actionable to the point of care.”
The ACP policy paper “Envisioning a Better U.S. Health Care System for All: Health Care Delivery and Payment System Reforms” is available on the Annals of Internal Medicine website.