Year in Research Nominee for 2010

Most physicians believe that Medicare reimbursements are inequitable but do not agree on how to reform the payment system.

The cost of health care has risen to levels that threaten the future of Medicare and the country’s economic well-being. Various physician reimbursement proposals aim to “bend the cost curve” of expenditures while improving health care quality.

Physicians’ views may be helpful in optimizing the design of any reimbursement reforms and researchers sought out their opinions regarding three reform strategies. Most of the respondents were men (73.1%), practiced in office settings (77.2%), and accepted Medicare (82%).

Key Findings:

• Incentives to improve quality (pay for performance) showed the highest level of support (49.1%) among physicians.
• Bundling payments, which pays physicians a fixed amount for a set of services under one episode of care, was viewed unfavorably with 69.1 percent of physicians opposing it.
• Shifting payments from procedures to management and counseling services was supported by 41.6 percent and was favored more by generalists (66.5%) than surgeons (16.6%). While there was broad support for increasing pay for generalists (79.8%), paying for the increase with a 3 percent reduction in specialist reimbursement was endorsed by only 39.1 percent of physicians.

As Michael Chernew, Ph.D., advises in a related commentary, “the sooner we develop payment strategies that provide adequate resources and incentives for efficiencies, the better off we will all be.”