Guess what? Physicians want to have veto power over new health care payment schemes designed to save money. And they won't approve such schemes without first seeing lots of compelling evidence that the new systems save money and lead to better patient outcomes.
This is just in from a Robert Wood Johnson Foundation query of 18 noted physicians. RWJ asked these practitioners to discuss the parameters they would set for strategies designed to reduce health care costs in America. They panelists agreed upon five major points:
1. Payment models must be evidence-based, physician-endorsed, and thoroughly tested.
Without this first step, designed to win support from the medical community, those trying to contain costs will continue to fight the fight without the strong backing of clinicians. They also said it would be imperative that The Centers of Medicare and Medicaid Services lead any testing of models, since CMS is the largest healthcare payer.
2. Protecting and creating financial incentives is critical to broad physician buy-in.
With physician income already heading south, the panelists expressed their fears that, without safeguards for how much they would make under any new model, they probably would fight it.
3. Meaningful consumer engagement requires better communication and guidance from physicians, more willingness from consumers, and greater investments in prevention.
While this one may perhaps seem to stretch the limits of “a major point,” the gist is that physicians are beginning to realize there's a huge communications gap between themselves and their staff, and most of their patients. These physicians expressed little confidence in their patients’ abilities to comprehend and effectively use information about treatment options and relative costs. But they did allow that there is probably some advantage to at least introducing the concepts of cost and procedure alternatives to their patients. And they agreed that discussing prevention and wellness with patients should be part of any conversation.
4. Improving quality and reducing cost requires a stronger health information technology infrastructure.
This was another of those weak endorsements of the obvious. To quote RWJ: “The panelists agreed that greater investment in health IT was need by both payers and providers. Still, most panelists remained cautious about [electronic health records] implementation because of cost and workplace disruption.” C'mon guys, it's now required.
5. Major changes in education and practice are needed to help reduce costs.
The physicians hit on a good point when they traced some of the roots of the current cost situation to a lack of discussion of the costs of providing care in med school. “Physician members are deeply concerned about the paucity of medical education related to health care costs, and encourage broad efforts to better educate both practicing and training physicians on the relative costs of their clinical decision-making,” the study said.