Background: Guiding health care delivery towards patient-centered value can be accelerated by reforming physician reimbursement. Recent legislation including the Medicare Access and CHIP Reauthorization Act (MACRA) and the Affordable Care Act have created frameworks for value-based health care payments. By the end of 2018, the United States Department of Health and Human Services aims to have 90% of Medicare fee-for-service payments tied to quality or value with 50% being paid through alternative payment models. The current level of physician and trainee understanding of reimbursement models and value-based incentives is unknown.
Methods: An anonymous survey was administered at an internal medicine multidisciplinary conference with medical students, residents, faculty, nurses, and hospital administrators in attendance. Using a 1-to-5 scale, the survey asked to rate familiarity with several key topics related to physician reimbursement and value-based payments as well as interest in further education. The topics were value-based payments (VBP), Medicare sustainable growth rate (SGR), MACRA, merit-based incentive payment system (MIPS), advanced alternative payment models (APM), accountable care organizations (ACO), and the relative value scale update committee (RUC).
Results: Twenty-nine participants returned surveys including 11 trainees (residents and medical students), 8 faculty, and 10 others. On a scale of 1-to-5, trainee knowledge ranged from 1.27 (RUC) to 2.45 (VBP). Faculty knowledge ranged from 2 (APM) to 3.13 (ACO). Interest in learning more about these topics was rated at 5 among trainees and 4.63 among faculty.
Conclusions: While there is significant interest in physician reimbursement models and value-based payments among faculty and trainees, self-reported familiarity with these concepts is low in both groups. Faculty reported only a slightly greater understanding of these topics than trainees. This suggests that training programs may not be able to address critical career preparation needs without additional training resources. This knowledge gap may be systemic as many medical trainees are taught by academic physicians who are salaried and are only indirectly affected by reimbursement from payers. While this survey studied a limited sample at a single institution, the results suggest there is a need for formal education on physician reimbursement models and value-based payments for both faculty and trainees.
