Physician Incentives Are Key to Quality, Value and Better Outcomes

Driving physician behavior in the age of MACRA

By Wael Barsoum, MD

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BPCI. APM. MACRA. These acronyms represent the major discussion topics in the business of healthcare today. The crux of these new goals is to enable a pay-for-performance environment that’s focused on quality, value and accountability. I suggest that we add a critical component to those discussions — physician behavior and compensation and their role in decision-making.

In our free-market economy, financial incentives are commonly used to drive down costs and increase profits. However, in medicine, the higher volume of appointments, tests or procedures performed in treating a patient doesn’t equate with practicing better medicine.

So, how do we modify the current innovative payment models to make them more receptive to the market? And how do we use the financial incentives in healthcare to drive down cost?

The key issue is how we incentivize and drive physician behavior and decision-making. There is data that clearly shows that if you improve quality, you can also drive down cost. These are the factors that can change the status quo most efficiently. In the bargain, we also return the decision-making in healthcare to physicians.

In this era of MACRA (the Medicare Access and CHIP Reauthorization Act), CMS is incentivizing appropriate physician behavior to reduce costs, and physicians are making clinical decisions to support these new goals. Just two decades ago, we jeered at the idea of drive-by surgeries. Today, we — physicians and consumers — support the idea that many surgeries can be performed in an ambulatory surgical environment, and the data confirms that patients heal better at home following most procedures.

Outpatient surgical centers were also under the scrutiny and critical gaze of the media and healthcare industry’s many partners a couple of decades ago. Facilities are required to be transparent about their physician investors today. Doesn’t it make sense that if your physician is a partner in a facility, he wants to ensure the care you receive is exemplary?

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As a surgeon, I am now planning for the probability of an outpatient procedure for many patients, even for something as complex as a hip replacement. For the right patient, it’s the right thing to do. It’s right for society when physicians using best medical practices drive down the overall cost of care and deservedly keep more of the bundled payment as a result.

Approaches like MACRA, BPCI (Bundled Payments for Care Improvement) and APM (Alternate Payment Models) are the right strategies on many levels. Why are we waiting for payers to make these determinations? The fact that CMS is dictating the change is pushing many of the wrong buttons whereas the physician practicing quality medicine has a good deal of control in this environment.

If we can step back and think globally about our current economic model, it’s clear that spending 18 or 19 percent of the U.S. GDP on healthcare comes at a huge cost to education and social services. If we can move the needle on quality, the impact will be on both a micro and macro level.

Whether as leaders of our practice, a hospital or community, we need to make decisions that support a better future for everyone.

Making the payment model more responsive to physician control takes us back to the days when we could trust the family doctor to do the right thing for everyone in the pipeline, starting with the patient. Knowing it’s being done from the standpoint of quality outcomes is the secret sauce that may make bundled payments a turning point for physicians, not just payors.

It’s the right thing to do for the right reason.

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I welcome the opportunity to control my patients’ care plans in this new age. I know it will also make Cleveland Clinic Florida a stronger institution and support the world-class care that our patients expect.

Learn to become a physician leader with Cleveland Clinic Global Executive Education programs, including The Cleveland Clinic Way: IntensivesSamson Global Leadership Academy and the Executive Visitors’ Program.

Dr. Barsoum is President of Cleveland Clinic Florida and staff in the Department of Orthopaedic Surgery.