全球智库信息集成服务系统

Payment Models Affect Practices

• Multiple practice leaders and market interviewees reported that their own practices or others in their markets were changing their organizational models in response to new payment models.
• Respondents perceived that alternative payment models have encouraged the development of team approaches to care management.
• Market observers and physician practices reported that global capitation and related shared savings models were changing relationships between primary care and subspecialist physicians.
• Physician practices reported making significant investments in their data management capabilities to track and improve performance in alternative payment models.
• The multiplicity of pay-for-performance and other incentive programs has created a heavy administrative burden for some physician practices.

Payment Models Affect Physicians

• The financial incentives applied to physician practices via alternative payment models were not simply "passed through" to individual physicians. Practice leaders described transforming certain practice-level financial incentives into internal nonfinancial incentives for individual physicians. Leaders acknowledged the presence of inconsistencies between financial and nonfinancial incentives. Alternative payment models had negligible effects on the aggregate income of individual physicians within the sample. Some physicians reported wanting to have their incomes more closely linked to quality and efficiency of care.
• Alternative payment models have not substantially changed how physicians delivered face-to-face patient care. Additional nonclinical work created significant discontent. Most physicians in practice leadership positions were optimistic and enthusiastic about alternative payment models, while most physicians not in leadership roles expressed at least some level of apprehension.