Going Global: Health Officials Trumpet Moving Away from Fee-for-Service System

Les Masterson, for HealthLeaders Media , October 22, 2009

"We have tried to build a global payment 2.0 if you will—a new system that works with physicians," said Dreyfus.

All of the health officials agreed that physicians must play a key part in payment reform. Lee said he hopes for a "co-evolution" in the way that providers and payers relate to one another, which will create a system will more efficient care.

His fears are that either payment reform is not well thought-out and causes a provider backlash or—even worse—there are no attempts made to move away from the fee-for-service system.

"If we're unable to do anything, then we'll have the same fragmented payment system, but increasingly inadequate," said Lee.

Miller said physicians have to be the ones pushing for payment reform. Having policymakers tell providers how to do things won't gain physician support, he said.

Lee said he was a capitation booster in the 1990s and learned from the experience that providers must understand risk—and the system can't merely put all the risk on providers.

In addition to educating physicians and getting buy-in, Miller said the healthcare system must educate patients in terms like the medical home and global payment. They may mistakenly think the terms mean nursing home and needing to get care in another country, he added.

Part of that education is telling people that global payments will not lead to "rationing," but are a way to incentivize doctors who keep patients out of the hospital, cut down hospital infections, and reduce costs, said Miller. He added that a new payment system must also involve patients by rewarding those who choose the highest quality providers.

Les Masterson is an editor for HealthLeaders Media.

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