New Possible Payment Models

In earth-shattering news, a new type of payment model has been proposed to HHS that would “provide greater financial resources to family physicians and primary care”. The answer?  Patients actually pay their doctors directly using cash, credit card or their HSA account.  A simple and effective approach that has worked for all businesses since commerce began.  Gotcha!!  I’m kidding.  Why would big bureaucratic groups want something simple?  They would lose their jobs if that happened.  No, instead here is the proposal by our friends at the AAFP:

The APC-APM would create a new payment structure for participating primary care practices consisting of a combination of four mechanisms:

• A prospective, risk-adjusted, primary care global payment for direct patient care;
• Fee-for-service limited to services not included in the primary care global fee;
• A prospective, risk-adjusted, population-based payment; and
• Performance-based incentive payments that hold physicians appropriately accountable for quality and costs.

Other features of the model require that physician practices be:

  • Fully flexible to accommodate differences in clinical settings and patient subgroups covered by primary care;
  • Able to be fully evaluated for quality and cost at the model and APM entity levels;
  • Reflective of the Joint Principles of the Patient-Centered Medical Home (PCMH) and the five key functions of the CPC+;
  • Attribute patients based primarily on patient choice; and
  • Adopt, and ultimately use, interoperable, certified health information technology, with the expectation that at least 50% of qualifying participants will use certified electronic health record technology (CEHRT).

Got it?  It’s so simple! Sure the quality stuff is unproven. Sure the PCMH and CPC+ is unproven. But who cares?  This all makes perfect sense to the “smart people”.  You know what also makes perfect sense? Scrapping it all.  But what do I know? I am just a lowly family doc in the trenches watching from the sidelines.

I also heard the AMA is coming out with their own payment model proposal that is all based on Monopoly money and scratch tickets. I am pretty excited about that one. Dilly Dilly.

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