Just finished up with the “Models for Payment Reform” panel at ACC’s 2009 Health System Reform Summit, featuring ACC Senior VP of Quality and Science Janet Wright, M.D., F.A.C.C., Bob Berenson, senior fellow at the Urban Institute, and Gail Wilensky, senior fellow at Project HOPE and a former CMS administrator. 

Janet spoke about reaching out to other specialties to form quality networks in order to improve care. I wonder: How do we move physicians into these quality networks? This will require a business case, which doesn’t exist currently.  

Berenson spoke about the different payment systems currently in place and the payment systems that have been talked about for the future, including pay-for-performance, paying for episodes of care or bundled episodes of care. He concluded that given the heterogeneity of payment systems and the readiness of many physicians to try new systems, the country may no longer need a one-size-fits-all solution like the SGRrrr. However, there must be incentives to move physicians into these new payment systems.

Wilensky called the payment system the “most broken screwed up” part of Medicare, claiming that the current system of the SGR and RBRVS (Resource-Based Relative Value Scale, which assigns payment based on the resource cost of providing a service) can’t work because there is a basic disconnect between payment incentives and the physician – meaning that nothing the physician does will influence total spending. However, she warned that doing away with the SGRrrr is never going to happen, so we need to either have an SGR closer to the practice level or move the system toward bundling payments. p.s. I’m not sure I buy that. We need more innovative concepts that aren’t even on the table yet, like using our registries to reduce disparities and variations, or gainsharing between payers and physicians and patients, which could bring down the overall costs. We need to think of new solutions.

What do you think: What’s the best way to reform the payment system?