Opinion: Importance of payment reform cannot be overstated

By Michael Pramenko, M.D.

Earlier this year, more than 100 physicians attended the Colorado Medical Society (CMS) Physician Summit on Payment Reform in Denver. Ninety-eight percent of them left the summit wanting to hear more and willing to stay involved with the discussion.

The importance of payment reform cannot be overstated. Heres why.

For years now, physicians have been talking about how the practice of medicine is changing. Weve been talking about our new realities, including decreasing reimbursement relative to inflation and the difficulty of maintaining a practice. At the same time, a wide range of public and private stakeholders, have recognized that the current health system is financially unsustainable and have been talking exploring ways to improve care that is also more cost effective. The main value-driving elements to this proposition are improved access and care coordination. New payment systems must be developed and operationalized with physician input in a manner that incentivizes us to practice medicine using new models that provide high quality, cost effective patient care. The dots have to get connected if the new models of care are going to be successful.

How can physicians modify our practices and invest in technology when the current fee-for-service payment system incentivizes the status quo? The tools that are fundamental to powering these value-driven elements are health information technology and payment reform. Many physicians are simply caught between a rock and a hard place during this time of transition. They are working hard to ramp up technologically, which, as we all know, is much more complicated than simply installing new equipment and hitting the on button. The specific problem for many of our colleagues is the inability to proceed with needed technological and logistical practice changes due to a lack of financial capital and payment systems that link back to the desired outcomes of more cost-effective, improved care. Make no mistake, doctors are being asked to change while the current payment structure for physicians relentlessly directs them down the same old path.

Physicians recognize the need for integrated care. Physicians realize the need for bending the cost curve and improving the quality of health care in Colorado. Many physicians have come to recognize that the current payment system is failingphysicians and patients by failing to incentivize what is needed for us to provide high quality care for our patients in the rapidly evolving new health care environment. New payment models can play a critical role in transitioning our respective practices to achieve our goals. In other words, we cant get where we want to be by building on the current payment model unless the Congress, the legislature and business decide to seriously upgrade reimbursement. We cant get there from here.

So what are our options in payment reform? Renowned payment reform expert Harold Miller has said that the current payment system has created an environment where existing stakeholders think that each can only gain at the others expense, whereas he believes that there are win-win opportunities for everyone if they could work together to find them. If we are committed to seize win-win opportunities to ensure that payment and delivery system reforms evolve in the right way, then we need physicians at the table shaping the conversation.

This win-win concept provides the perfect framework for our future conversations within the house of medicine and with other critical stakeholders.

On your behalf, CMS is seeking solutions to these barriers that impede our progress. A project of this size and scope will require collaboration, cooperation and leadership. It will require all of us working together to find the win-win payment reform scenarios. It will require us to think in a new way and that new way of thinking will apply to other stakeholders as well. Health plans, health systems, employers and consumers are all critical to this discussion.

These, and other important questions, are being debated at CMS. Indeed, to reach the lofty goals of health reform we will need stronger lines of communication within the house of medicine and new relationships and new collaboration with other stakeholders, such as hospitals, payers, business and consumers. Is that possible? Is that a realistic expectation? Whether or not it is realistic or possible, we cannot sit on the sidelines. The conversation is underway for the good of the patient, the economy, other stakeholders and our profession.

Despite the difficult task at hand, CMS is developing a path to move forward on payment reform by reaching out to our members, creating cross-specialty discussions that are collegial and safe, and building new bridges, new partnerships and new projects. This means greater collaboration at a level previously deemed impossible. If a state exists that can do this, I believe that it is Colorado. CMS is open for business and ready to meet with any and all stakeholders to find the win-win scenarios that benefit all and increase the quality of health care in Colorado. Let me know what you are thinking by contacting me at president@cms.org.

Michael J. Pramenko, MD is a family physician in Grand Junction and president of the Colorado Medical Society. He is one of 15 members of the federal CO-OP Advisory Board, appointed by the U.S. Comptroller General to advise the Secretary of Health and Human Services and the U.S. Congress on the creation of qualified nonprofit health plans as part of the Patient Protection and Affordable Care Act enacted in 2010.

Opinions communicated in Solutions represent the view of individual authors, and may not reflect the position of the University of Colorado Denver or the University of Colorado system.