More than half of America’s doctors are not buying into the value-based care model introduced by the Affordable Care Act (ACA), a new survey reveals. Doctors receiving compensation based on the model are not convinced that it can genuinely improve patient outcomes or reduce the overall cost of care.
Healthcare Informatics reports on the research from The Physicians Foundation, based on a 2018 survey of U.S. physicians conducted with the help of Merritt Hawkins. Data was collected from some 9,000 doctors located throughout the country. It is not clear how many of the survey respondents were private practice owners versus permanently employed doctors and locum tenens providers. At any rate, the survey results are a wake-up call.
Doctors Are Not Sold
If the survey data is accurate, it reveals a systemic weakness of value-based care that very few expected to observe some eight years after the ACA was signed into law. That weakness is the fact that doctors are unsure what constitutes real value. One doctor explained that “we are no longer in the business of healthcare delivery, we are in the business of measures delivery,” reports Healthcare Informatics.
According to the survey:
- 47% of doctors say their pay is tied to quality or value
- 57% do not believe that value-based payments improve quality or reduce costs
- 88% say that social determinants play a significant role in patient outcomes
- 80% say that value-based care overextends doctors
- 40% say that value-based care will lead to either retirement or reduced working hours over the next three years
- 46% say the current relationships between doctors and hospitals are strained due to value payments.
The numbers are startling in light of the fact that that the fee-for-service model that preceded the ACA was so severely criticized in the years leading up to passage of the law. Fee-for-service was vilified as being all about generating profits for insurance companies rather than actually guaranteeing better health for patients. And yet, doctors say patients are no better off as a result of value-based care.
Facing Unclear Metrics
The survey also revealed that doctors are struggling with unclear metrics. Many of the doctors surveyed do not even know whether their payments are tied to value. And among those who do know they are being paid on value, many struggle to understand the metrics that determine how much they are paid.
It could be that doctors are struggling simply because value-based medicine is so new. Some of the oldest doctors in the country had already been practicing for decades prior to the introduction of the value-based model. Combined with the difficulty posed by electronic record keeping regulations, value-based metrics could just be too much for them to wrap their brains around.
Something Needs to Change
It should be noted that the survey results do not necessarily dictate that value-based medicine is a bad deal. It may not be at all. It just means that America’s doctors are not quite on board with it yet. This should not be surprising. Change in the medical field has always been laboriously slow. What another industry is willing to embrace overnight generally takes the medical profession years to come to terms with.
More data needs to be compiled before any decisive conclusions on value-based care can be made. In the meantime, something needs to be done to address the concerns of America’s doctors. As the ones who ultimately provide the care patients need, we cannot allow them to continue to be suspect of value-based care. If they do not believe in it, value-based medicine is ultimately doomed.