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Estudo de AMA-RAND: Os doutores necessitam a “sustentação e a orientação” em modelos novos do pagamento

por Lauren Dubinsky, Senior Reporter | March 19, 2015
Physician practices are embracing the new payment models but are realizing they need assistance in handling the growing amount of data and finding ways to respond to the many different programs and quality metrics from payors, according to a new RAND Corporation and American Medical Association (AMA) study.

In order to make the shift to the new models, a lot of physician practices need money up front to hire a nurse-case manager or install a new health information technology system, but that's usually beyond the financial reach of a small practice.

“That’s where you see some of the smaller practices especially feeling some pressure to join larger systems where the pockets are a little deeper, like a hospital that can supply staff and information technology," Dr. Mark W. Friedberg, the study's lead author and a senior natural scientist at RAND, told DOTmed News.

The researchers studied 34 physician practices around the world to get an idea of the impact the new payment models are having on them. The payment models examined were episode-based and bundled payments, shared savings, pay-for-performance, capitation, retainer-based practices, accountable care organizations and medical home.

They found that the practices are having challenges with reorganizing their operations with the models’ objectives because of lack of needed data and the fact that different models conflict with each other. The researchers recommend that payors find ways to harmonize aspects of the payment models including performance measures since practices deal with many payors with different performance measures tied to incentives.

Physician leaders reported being optimistic about the new models, but physicians who aren’t in leadership roles have concerns over new documentation requirements. They were on board with new patient registries that detail patients with particular health conditions to enhance care but were uncertain about other documentation requirements in which the connection to improved care is less clear.

The study also found that the operational details of the models are very important because they can make or break the practice’s efforts to improve their processes. Information systems are used to evaluate practice patterns but when information on quality performance feedback and drug prices is missing or incorrect then it’s hard for them to use the data analysis to actually improve care and cut costs.

The study recommends that payors should think about investing in the capability of the practices to manage the information because it can help the practices get the most out of electronic health records and other health information technology.

The study describes instances in which a physician received a bonus check for satisfying an incentive but didn't know what they did to receive that bonus and how to satisfy that incentive again in the future. “Sometimes you can safely assume that doctors sort of know what to do to perform well under the incentive but that’s not always the case," said Friedberg. “Some guidance is really helpful both about the intent of the incentive and also about how physician practices might most successfully achieve those goals.”

The findings of this study will be used by the AMA and other health care stakeholders to improve the models and assist practices in effectively adapting to the changes.

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