- Most physicians in group practices owned by health systems are paid based on the volume of care they provide rather than value, despite payer efforts to move toward more value-based care, according to a study published Friday by the nonprofit Rand Corporation and published in JAMA Health Forum.
- Volume-based compensation was the most common type of base pay for more than 80% of primary-care doctors and more than 90% of specialists at medical practices owned by health systems, according to a survey conducted between November 2017 and July 2019.
- Systems still used financial incentives for quality and cost performance measures, but the percentage of total physician compensation based on quality and cost was just 9% for primary-care providers and 5% for specialists, according to Rand.
Public and private payers in recent years have pushed for payment reforms encouraging providers to improve care quality and slow spending growth by making care more value based. Still, physicians overall still are paid primarily based on volume rather than the quality and value of healthcare services provided, according to the Rand study.
"The payment systems that are most-often in place are designed to maximize health system revenue by incentivizing providers within the system to deliver more services," Rachel Reid, the study's lead author and a physician policy researcher at Rand, said in a statement.
Researchers examined physician payment structures used in 31 physician organizations affiliated with 22 health systems located in four states. They also interviewed physician organization leaders and surveyed practices to characterize compensation arrangements for both primary care and specialty physicians.
Physicians most commonly reported increasing the volume of services performed as a way to increase their compensation, with about 70% of practices following those plans, and in those cases, incentives based on volume accounted for more than two-thirds of their compensation.
While incentives based on clinical quality, cost, patient experience and access to care also were commonly included in physician pay, those payments represented a small fraction of doctors' total compensation and are "likely to only marginally affect physician behavior," the study said.
"For the U.S. healthcare system to truly realize the potential of value-based payment reform and deliver better value for patients, health systems and provider organizations will likely need to evolve the way that frontline physicians are paid to better align with value," Reid said.