According to a position paper published June 21 in Annals of Internal Medicine by the American College of Physicians (ACP), the current fee-for-service payment structure for US physicians isn’t working and needs to be reformed. Their paper argues that the current model rewards quantity over quality and contributes to disparities in health care. They point out that, because of such disparities, socioeconomic status remains “one of the most clinically significant contributors to health outcomes in this country.”
The ACP offers several solutions to reform payment programs to achieve greater equity in health care as well as improve the quality of that care. In particular, they say that such reform should focus on achieving greater equity and value in health care, as well as prioritize underserved patient populations. The paper includes seven key recommendations, which are summarized below:
- Medicare and other payers should progressively adopt population-based, prospective payment models for primary and comprehensive care that are structured and sufficient to ensure underserved populations can access quality care
- Research into creating a validated way to measure the cost of caring for patients who face disparities and/or inequities in health care
- Modifications to the Medicare law to establish a mechanism for savings to be calculated across all aspects of the program
- The Secretary of Health and Human Services should be authorized to address the inadequacies within the Quality Payment Program
- Delivery and payment systems must fully support healthcare facilities, physicians, and other clinicians, so they can offer all patients the ability to receive care when and where they need it in the most appropriate manner possible, whether that care is provided virtually or in-person
- Adequate funding must be made available to support the development of effective health information technology systems and communication mechanisms, in order for payment and delivery reforms to serve the needs of all patients
- Various federal and state stakeholders and policymakers should develop and implement additional financing mechanisms beyond direct payment to clinicians and practices, such as grants and technical assistance to help solve social drivers of health, health care disparities, and inequities
The authors acknowledge that implementing these recommendations will require support from a number of sources, and that additional research will be needed to ensure the reforms are successful in eliminating inequities in health care.