An Observational Study of Provider Perspectives on Alternative Payment Models.

Over the past decade, reimbursement in the US health care system has undergone rapid transformation. The Affordable Care Act and the Medicare Access and CHIP Reauthorization Act are some of the many changes challenging traditional modes of practice and raising concerns about practitioners' ability to adapt. Recently, physician satisfaction was proposed as an addition to the Triple Aim in acknowledgment of how the physician's attitude can affect outcomes. To understand how physicians perceive alternative payment models (APMs) and how those perceptions may vary by their organizational role, non-leader physicians (N = 31), physician leaders (N = 67), and health system leaders (N = 49) were surveyed using a mixed-methods approach. Respondents to the electronic survey, who were identified from a Jefferson College of Population Health program participant database, rated their organizations' responses to APMs and provided commentary. Analysis of the Likert scale quantitative data indicates a significant difference in ratings between the 3 groups, particularly between health system leaders and non-leader physicians. The aggregated Attitudes Toward APMs Scale indicates that health system leaders were statistically significantly more likely to rate themselves and their organizations as better prepared for APMs compared to non-leader physicians and physician leaders. Qualitative analysis of comments indicates that non-leader physicians are more negative of APMs, often expressing frustration at added administrative burdens, barriers to implementation, and inconsistent or unclear measurement requirements. These findings indicate that the negative feelings non-leader physicians and physician leaders, in particular, expressed could contribute to physician burnout and decreased professional satisfaction, and impede the effective implementation of APMs.