Re-Defining a Paradigm of Care: Transforming Payment Models to Better Match With Physician Time and Effort (Grant Greenberg MD, MA)

The majority of ambulatory care clinics reimburse clinical work based upon a combination of patient volume and complexity of care via the work relative-value unit (wRVU) system. While some models of care utilize other reimbursement methods (e.g. concierge practice, pure capitation, cash only) and many systems now implement a component of payment for quality of care as a percentage of total reimbursement, current payment systems conflict with the Patient Centered Medical Home (PCMH) and Population Management approaches now being integrated across primary care disciplines. In the PCMH model, the goal is consistent with the IOM: to meet the needs of the patient in a safe, effective, efficient, personalized, timely, and equitable manner. Accomplishing this goal does not always require, and care and patient satisfaction may actually be improved without, a face-to-face billable encounter. Current reimbursement paradigms do not account for non-face-to-face encounters, which comprise a substantial and growing percentage of daily physician work. Transitioning to a model of reimbursement which accounts for a balance between in-person and asynchronous patient care, which maintains or augments patient expectations, presents a difficult challenge in balancing workflow and physician job satisfaction
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