The COVID-19 pandemic has been instrumental in further exacerbating problems in the U.S. health care realm that have existed for decades. Three principal aspects that continue to be of major concern are cost, quality, and accessibility. With the rare exception of the Patient Protection and Affordable Care Act (ACA) that became law in 2010, most efforts to improve matters have occurred incrementally rather than from a more sweeping perspective. Much progress has been made in efforts to lower costs, enhance quality in the delivery of health care services, and provide adequate health insurance coverage for individuals who lack it. Despite some impressive advances in all three areas, health care expenditures are fast approaching 20% of GDP, serious disparities exist that are harmful for several population subgroups, and substantial differences exist depending on whether individuals live in rural or urban areas. Regarding the latter consideration, as critical as personal genetic codes may be in governing the quality of health outcomes, Zip codes also play a determinative role in the availability and accessibility of essential health care services.
Physician Compensation And Financial U.S. Public Health System Care Developments
Since passage of the ACA, public and private payers in the U.S. have undertaken various payment reforms to improve quality and reduce spending. Alternative payment models (APMs) and value-based payment (VBP) seek to redirect the health system’s focus toward producing value instead of volume. Public and private payers continue to expand use of alternative payment models, aiming to use value-based payment to affect the care delivery of their contracted health system partners. In parallel, health systems and their employment of physicians continue to grow. A good question is the degree to which health system physician compensation reflects an orientation toward value, rather than volume. As reported on January 28, 2022 in JAMA Health Forum, an investigation that was a component of a larger RAND Health System Study was conducted with senior leaders among a purposive sample of health systems in California, Minnesota, Wisconsin, and Washington that were selected because of their advanced collection and public reporting of physician organization performance data through health care measurement and improvement collaboratives, and because they represented diverse market characteristics.
This cross-sectional mixed methods study of 31 physician organizations affiliated with 22 U.S. health systems found that volume was a component of primary care and specialist compensation for most physician organizations. Volume was the most common form of base compensation by a wide margin, being included by more than 80% and 90% of physician organizations and primary care physicians, respectively, and representing more than two-thirds of compensation when included. While most primary care and specialist compensation arrangements included performance-based incentives, they averaged less than 10% of compensation. These study results suggest that despite growth in value-based payment arrangements from payers, health systems currently incentivize physicians to maximize volume, thereby maximizing health system revenues. Increasing the volume of services was the most commonly cited action for physicians to increase compensation, reported as the top action by 22 physician organizations (70.0%) for primary care physicians and specialists. A conclusion is that greater translation of the value-over-volume incentives of payers into physician compensation may be necessary to realize the full potential of value-oriented payment reform.
Adequacy Of The Federal Response To COVID_19
The Government Accountability Office (GAO), the auditing arm of the U.S. Congress that is the equivalent of a federal watchdog, has criticized the Department of Health and Human Services (HHS) for “persistent difficulties” in its response to the coronavirus pandemic and past public health emergencies. For example, HHS still is viewed as having no comprehensive COVID-19 testing strategy, according to a report from the GAO that was released on January 27, 2022. The problems date back more than 10 years to other crises, including the H1N1 influenza pandemic, the Zika and Ebola virus outbreaks, and public health threats posed by natural disasters, such as hurricanes. These failures are viewed as leaving the nation vulnerable to future viruses and weather events, according to the report. In tandem with the release of the document, GAO announced it has added HHS leadership and public health emergency coordination to its list of “high-risk” issues that Congress and the executive branch should address. The list now highlights 37 problems at more than a dozen agencies, with some dating back to 1990.