Robertson-Cooper Heidy, Neaderhiser Bradley, Happe Laura E, Beveridge Roy A
1 American Academy of Family Physicians (AAFP) (at the time the study was conducted), Leawood, Kansas.
2 Humana Inc. , Louisville, Kentucky.
Popul Health Manag. 2017 Oct;20(5):357-361. doi: 10.1089/pop.2016.0135. Epub 2017 Jan 18.
Value-based payments are rapidly replacing fee-for-service arrangements, necessitating advancements in physician practice capabilities and functions. The objective of this study was to examine potential differences among family physicians who are owners versus employed with respect to their readiness for value-based payment models. The authors surveyed more than 550 family physicians from the American Academy of Family Physician's membership; nearly 75% had made changes to participate in value-based payments. However, owners were significantly more likely to report that their practices had made no changes in value-based payment capabilities than employed physicians (owners 35.2% vs. employed 18.1%, P < 0.05). This study identified 3 key areas in which physician owners' value-based practice capabilities were not as advanced as the employed physician group: (1) quality improvement strategies, (2) human capital investment, and (3) identification of high-risk patients. Specifically, the employed physician group reported more quality improvement strategies, including quality measures, Plan-Do-Study-Act, root cause analysis, and Lean Six Sigma (P < 0.05 for all). More employed physicians reported that their practices had full-time care management staff (19.8% owners vs. 30.8% employed, P < 0.05), while owners were more likely to report that they had no resources/capacity to hire care managers or care coordinators (31.4% owners vs. 19.4% employed, P < 0.05). Owners were significantly more likely to respond that they do not have the resources/capacity to identify high-risk patients (23.1% owners vs. 19.3% employed, P < 0.05). As public and private payers transition to value-based payments, consideration of different population health management needs according to ownership status has the potential to support the adoption of value-based care delivery for family physicians.
基于价值的支付方式正在迅速取代按服务收费的安排，这就需要提升医生执业能力和职能。本研究的目的是考察个体执业的家庭医生和受雇的家庭医生在对基于价值的支付模式的准备程度上的潜在差异。作者对美国家庭医生学会会员中的550多名家庭医生进行了调查；近75%的人已做出改变以参与基于价值的支付。然而，个体执业医生比受雇医生更有可能报告称其诊所基于价值的支付能力未发生变化（个体执业医生为35.2%，受雇医生为18.1%，P<0.05）。本研究确定了个体执业医生基于价值的执业能力不如受雇医生群体先进的3个关键领域：（1）质量改进策略，（2）人力资本投资，以及（3）高风险患者识别。具体而言，受雇医生群体报告了更多的质量改进策略，包括质量指标、计划-执行-研究-行动、根本原因分析和精益六西格玛（所有P<0.05）。更多受雇医生报告其诊所有全职护理管理人员（个体执业医生为19.8%，受雇医生为30.8%，P<0.05），而个体执业医生更有可能报告称他们没有资源/能力雇佣护理经理或护理协调员（个体执业医生为31.4%，受雇医生为19.4%，P<0.05）。个体执业医生显著更有可能回答称他们没有资源/能力识别高风险患者（个体执业医生为23.1%，受雇医生为19.3%，P<0.05）。随着公共和私人支付方转向基于价值的支付，根据执业身份考虑不同的人群健康管理需求有可能支持家庭医生采用基于价值的医疗服务提供模式。
