He discussed numbers, in what he called an “oversimplified” example borrowed from the Center for Healthcare Quality and Payment Reform, showing that it is possible for physicians to increase their payment while, at the same time, hospitals decrease their payment but increase their profitability, with purchases and patients saving money in the end.
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November 2014Whatever changes an otolaryngologist might make to his or her practice, new payment models are only useful “to us as physicians if they truly incentivize superior care and outcomes.”
“It isn’t just data, data, data, and more data,” he said. “It is outcomes data. We have to know what works.”
Questions Remain
Rob Green, MD, president of ENT and Allergy Associates in White Plains, N.Y., expressed the unease many otolaryngologists are experiencing.
“As we consider what’s going on in the marketplace, my question for you is how do we advise those of us at this point in time who wish to maintain independence? … Many of us are sitting out there really not knowing what to do,” he said.
“Everybody should do what they can to look at outcomes data,” said Dr. Nielsen. When you have that data, the next time you contract with anyone, you are armed with information, he added. “Look for the little things you can do that will either improve resource use or increase outcomes that you can use as evidence, and get in the habit of using that evidence every time you talk to somebody to negotiate a process.”
The moderator of the session, K.J. Lee, MD, founder of Virginia-based Simplicity EMR and former president of AAO-HNS, said otolaryngologists should not feel the need to make any firm decisions about ACO participation just yet. “Pay attention to what an ACO is, but don’t jump into joining quite yet,” he said. “It’s bound to be changing, and ACOs are going to change into various different forms. And, since otolaryngology is such a small portion of the total healthcare budget, nobody’s paying attention to us. So, by the same token, we can just sit by the sideline, study it, and strategize from there.”
He added, “The light at the end of the tunnel is that there will be an alternative payment system in which you can take into consideration the volume of care that you render at the same time, [considering] how good a steward of the healthcare dollar you are—the so-called ‘hybrid’ payment system.”