A week after seeming to reach consensus that a global payment
system is the ultimate payment model of choice, the state Payment
Reform Commission today turned to transitional issues. The key
question was how should the state move from a system based largely
on fee for service, to one that builds upon on capitation, without
its well-documented shortcomings.
The commission focused on three transitional issues:
- A transition timeline
- How to support providers during the transition
- Whether a carrot or stick approach will work best
There was general agreement that a three- to five-year timeline
to have most or all providers aligned under a global payment system
would be feasible, but there was no consensus as to when the
countdown would or should begin.
The commission unanimously agreed that providers will need
support to make the transition. The necessary forms of support
identified included:
- Common performance metrics
- Help implementing information technology
- Data transparency (especially with health plans), plus
analytical tools
- Help for small practices to integrate into larger provider
networks
- The level of necessary support will depend on a provider's
state of readiness and familiarity with managing global
payment.
The most vigorous discussion revolved around whether to
encourage the transition with carrots or sticks.
Commission member Alice Coombs, M.D., MMS vice president,
suggested that practices needing the most transitional support
might be positively reinforced by receiving several months' worth
of global payments up front. She also cautioned that a purely
punitive approach would likely not garner physician support.
Some commission members suggested making fee-for-service
payments unpalatable as a method to drive providers toward
accepting global payment, while others suggested setting a firm
target date for providers to be fully involved in global payment.
The commission reached no consensus about what the implied "or
else" would be under the latter plan for providers who did not
conform.
Amid the carrot-or-stick debate ran differences of opinion about
the appropriate role of government in facilitating the transition.
Rate-setting and government-mandated milestones toward global
payment were discussed, as was a more voluntary approach with
limited government intervention. No consensus was reached.
The commission meets next on May 8, with its final meeting
scheduled for May 26. Between now and May 8, commission
representatives will reconvene with stakeholders to get input on
the commission's work so far.
