Payment reform: Prepare for the future

September 23, 2013

When it comes to how urologists are paid, change is coming.

Dr. Snyder, a member of the Urology Times Editorial Council, is professor of surgery in the department of urology at the University of Pennsylvania School of Medicine, Philadelphia.

When it comes to how urologists are paid, change is coming. The current reimbursement system for all physicians-based on the flawed sustainable growth rate (SGR) formula-is no longer sustainable.

Congress is currently considering several proposals for replacing the SGR, one of which, H.R. 2810, received a unanimous 51-0 vote of support from the House Energy & Commerce Committee in July. (See Bob Gatty’s “Washington and You” column for details.) This bill is not ready for prime time, and many details-including how to pay for it-have yet to be ironed out. But it acknowledges that the SGR must be replaced and that physician input on its replacement is needed, both of which are great steps forward.

In short, it’s clear that the fee-for-service model as we know it will go away within the next 3 to 5 years. Like it or not, that change is inevitable. What’s less clear is what type of payment model (or models) will take its place. Suffice it to say that any new approach to physician compensation will be based on quality metrics: surgical outcomes, readmission rates, and complications, to name a few. Ultimately, the goal is high-value, cost-effective care.

As discussed in this issue of Urology Times, the bundled payment model is one approach that may make its mark in a post-SGR world. In this model, multiple providers-surgeon, anesthesiologist, and hospital, among others-are placed in the same financial risk pool. Rather than making multiple payments to these providers, the payer would make one payment to a single entity, usually a hospital, which allocates the money among the participants.

The bundling concept is one based on shared responsibility for patient care and shared profit. As a result, it will require a commitment to teamwork and collaboration among providers whose cooperation may have been limited in the past.

My advice is to educate yourself now about bundled payments and other new payment models that are being tested or under consideration. It’s time for physicians, including urologists, to face the future and start participating in value-based care.UT

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