Physicians Fear Value-based Care Compromises Health Care Quality

Stakeholders are generally skeptical about the shift from volume to value except for policy leaders

The current trend towards value-based care with the shift from fee-for-service to a fee-for-value model is controversial among stakeholders.

Physicians and other health care providers believe the transformation towards value-based care may negatively affect the quality of care in the United States and are particularly concerned about key elements, such as the rise in accountable care organizations (ACOs), the use of patient satisfaction surveys to determine physician bonuses, the consolidation of smaller hospitals and provider groups into large health systems, bundled payments and the shift of doctors from private practitioners to salaried employees.

And while policy leaders are generally positive about the evolution towards value-based care, payers and patients tend to be skeptical leaving room to be convinced.

APCO Insight conducted a survey from October 12, 2016 to January 5, 2017 that included responses from 1349 stakeholders, comprised of 690 health care providers (physicians and other providers such as nurses), 555 patient opinion leaders, 78 payers and 26 policy leaders. Below are some key findings from that research:

Opinions About Key Trends in the Shift Towards Value-Based Care

The audiences differ markedly in their opinions about the shift towards value-based care.

A majority among patients, payers and policy leaders believe that initiatives aimed at improving quality, efficiency and overall value of health care by providing financial incentives for meeting improvement in patient outcomes will improve the quality of healthcare in the United States. Yet, only two-in-five health care providers agree with this.

Health care providers are seeing other trends as having a negative impact on the quality of care, such as the rise in ACOs, the use of patient satisfaction surveys to determine physician bonuses and the consolidation of smaller, independent hospitals and provider groups into large health systems. Other audiences are more willing to embrace them – especially policy leaders view toward the rise in ACOs as positive.

Very harsh views are levied from health care providers on new business models that come from this transformation. Paying health care providers in “bundles” related to the episode of care, not each service provided, scores high among policy leaders, but not among health care providers themselves. Similarly, the change in employment of physicians from independent practitioners to salaried employees is viewed by the vast majority of health care providers as negatively impacting the quality of care, but welcomed by policy leaders.

Assessment of Survey Findings

Other recent surveys have shown a reluctance among U.S. physicians to embrace the shift towards value-based care. And, leaders of health systems and other industry leaders have expressed the need for ways to engage and align physicians with value-based care. However, this survey shows for the first time a potential link between health care provider discontent with the shift towards value-based care and the perceived decline in the quality of care in the United States over the last five years.

Given the economic and demographic pressures on the healthcare system in the United States, the trend towards value-based care will no doubt continue in one form or another. But the findings from this survey highlight the urgency of engaging physicians and other health care providers more directly in this important transformation. The shift from focusing on volume to value is a dramatic shift in the way physicians have been trained and told to practice medicine the last 30 years. It disrupts deeply rooted practice behaviors.

It will be critically important to ensure that the medical profession and other health care providers are given real opportunities and incentives to buy-in to and co-create new models for value-based care that they themselves trust and believe will elevate the quality of their care. This will likely entail models for value-based care that are voluntary as opposed to mandatory, that are built from the bottom-up rather than by central policy decree, and that engage physician and provider organizations in open dialogue about how best to advance the quality of care while also controlling costs and providing more efficient care.

Health Care ProviderResearchValue Based Care