An interesting comment was made in an opinion piece by the American College of Physician from May, regarding the Medicare incentive program that gives physicians a 10 percent bonus on particular types of visits from January 2011 through December 2015.
“While the College recognizes that a 10 percent incentive payment on some primary care services, while significant, is not by itself sufficient to ensure an adequate supply of general internists and other primary care physicians, allowing it to expire would compound the shortage of primary care physicians, making it more difficult for established primary care physicians to continue to see Medicare patients or accept new ones and making it less likely that medical students will choose careers in primary care.”
The incentive program, which will likely not be extended, started because, given the changes in reimbursement models being planned, the value of the entry point into healthcare — the primary-care physician — was at risk.
What struck me about the statement was the fact that the 10 percent incentive payment itself was not sufficient to increase the supply of primary-care physicians. In real physician income, this type of incentive is not even sufficient to effectuate the Medical Home model or even the initiatives necessary to generate more care coordination — the distilled service that came from the Medical Home model.
Most recently, the initiatives that we have seen in physician reimbursement have been about “paying for quality.” However, the underlying issue is really in the cost of care. Almost every initiative is measured by how it controls cost. There is true genius in the overall plan that moves away from fee for service to one that includes results as a significant component of care. However, when there is a question of cost-versus-quality in decision making by those running the show, we know that cost will ultimately win. There will be some quality benefits certainly, but ultimately the goal is all about reducing the cost of care.
Concierge care differs though in that it generates quality, with larger incentives. As a payment system that takes cost out of the hands of the insurers and government and puts it firmly into the hands of the consumer, concierge recognizes the value of the physician in the equation. Unlike government initiatives, its success in a practice is purely about delivering on the promises that it makes. Generally they are about three things: Time, time and time. Concierge programs include greater connectivity to the provider, not just the practice, greater individual availability, and stronger individual relationships.
The current initiatives regarding physician reimbursement do not include these elements; they do not recognize the value these elements bring to quality healthcare. When the individual provider is no longer valued and there is a team approach to care, there is no question that cost is reduced. Teams include various levels of providers whose time is valued differently. Teams may not be better than a well compensated physician delivering the management and delivery of care, but this approach is valued because of the cost reduction.
To add quality time to the equation by an actual primary-care physician, delivering more broadly the concierge approach, far more than a 10 percent increase is needed. I agree with the ACP, and hope that the government does extend the 10 percent incentive program. But remember, cost is king. And if that incentive does nothing to reduce costs, it may be on the chopping block.