At my last annual physical, I spent almost an hour in the waiting room and only seven minutes talking to my doctor. When it was time for my pelvic exam, she asked me to disrobe and stated she’d be back in two minutes. I quickly changed into a flimsy paper gown and awaited her return. During those “two minutes,” I was able to overhear her entire visit and conversation with another patient. Needless to say, my time felt like it could have been better spent elsewhere—and in warmer clothing.
Few health care providers have time to spare, largely because our current profit-driven health care system actively creates and perpetuates barriers to quality care. In response to this complex challenge, CCMU has been paying close attention to payment reform as a commonsense solution. In most cases, providers are currently paid for each service they provide; so, in order to keep their practice running, they must increase their volume of patients and decrease the amount of time spent with each one. To reverse that trend, and increase the amount of quality time a provider can spend with a patient, it will require our health care system to move away from volume-driven health care payment to more value-based payments that allow providers greater flexibility.
Payment reform seems to be the natural pathway to better care experiences and health outcomes for patients. As with any substantial change to a major system, though, it is also important to be mindful of unintended consequences. For example, last fall, the Center for Medicare and Medicaid Services released the final rule for the Medicare Access and CHIP Reauthorization Act, or MACRA. The goal of this 2015 legislation was to push for more Medicare payments tied to value and quality. Unfortunately, it left room for incentives that can actually worsen access to quality care for Medicare patients. Most notably, MACRA offers five years of small, yearly payment bumps followed by no change for five years. This built-in cap could do more harm than good for physicians—especially those in small practices—and for Medicare patients, who might end up being unable to access care if providers have to limit the number of patients they see due to financial constraints.
We believe payment reforms must be built around structures that give health care providers the flexibility and financial sufficiency to meet patients’ needs. To that end, we support alternative payment models that can meet high care delivery standards and don’t cause unintentional harm. And, we will continue to look for opportunities to involve patients in the process of determining these quality metrics and implementing payment mechanisms that can ensure they are met. Hopefully we won’t keep patients waiting for quality time with their providers much longer!