Colorado payment reform: Specialty physician perspective

Thursday, March 01, 2012 12:20 PM

Chet Seward, Senior Director, Health Care Policy

Alan Synn, MD, is a part of a Denver-based five-person, vascular surgery group, which is the largest in the state. Colorado Medicine shared the health plan payment reform grid from pages 20-23 and asked him to respond to the following questions:

Q. As a specialist, what do you think of the payer payment reform initiatives?
A. I have approached health plans in the past and have been told that my subspecialty is below the radar as vascular surgery is too small in comparison to the other fiscally costly specialties such as cardiology, orthopedics and oncology.

I think specialist physicians have a lot of worries about these initiatives because they don’t have a clear understanding about how these programs work or how physician performance is going to be evaluated. Negotiating payment reforms with payers requires an intense amount of time, resources and financial expertise – more than what most practices have or will ever have.

Q. Are you currently participating in any of these programs?
A. My practice is not currently participating.

Q. What will it take for you to successfully participate in these programs?
A. There are a number of barriers that currently challenge our ability to participate in these initiatives. Like many of my specialist colleagues, I feel pretty intimidated in terms of the business expertise required to negotiate one of these deals. Another big problem is interoperability of information systems. While we are on an electronic health record (EHR), it is not connected to the hospital and if we’re going to do this successfully we know we are going to need good data.

Q. What is your perception of your colleagues’ ability to do this now?
A. As I think about specialists, the way to improve consistent measurable quality is to either narrow the distribution on quality or exclude outliers. If you avoid providing the care to those that are high risk, in other words the complex patients who tend to need these services the most, you haven’t helped the access problem. When my colleagues and I were in training, we always wanted to be the best surgeon who took on the most difficult cases. I worry that if we are not thoughtful with this [new approach], then the paradigm might shift to shying away from tackling complex cases. The motivation shifts to being “just good enough.” We need to be careful and patient-centered. We need to speak about measurable quality – in other words, measurable matrices that reflect quality care, in ways that include a patient’s quality of life. We cannot limit accessible care for high-risk complex patients.

Q. What advice would you give to physicians in terms of what they can do?
A. This is a topic of our time. Start engaging and learning more about these programs. Unless you’re 64 right now, you had better start paying attention because this is going to affect your practice life in major ways.