There is an escalating need to curtail skyrocketing health care costs in the U.S. Without major changes to the current system, the nation is on track to spend $4.5 trillion on health care by 2019. Contributing drivers include:
- The current fee-for-service system which rewards doctors for quantity not quality. Physicians are paid more to perform more procedures and order more tests, instead of better overall care.
- The lack of care coordination among providers. This results in duplication of services and tests, overtreatment, errors, and excessive administrative costs.
- An increasing number of patients accessing the health care system more often. They are older, have more chronic diseases, and often have more complex health problems.
- Physicians and patients continue to utilize high tech interventions that may or may not be necessary.
The National Commission on Physician Payment Reform was created by the Society of General Internal Medicine (SGIM) to assess how physicians are paid, and how pay incentives are linked to patient care. The independent commission is comprised of physicians from a wide range of medical specialties, representatives from health care, insurance, a state health department, health policy leaders and a consumer representative. The Commission is funded in part by the Robert Wood Johnson Foundation and the California Healthcare Foundation.
Over a year of deliberation, the Commission assessed payment and delivery models in place, efforts to incorporate quality into the current pay system, and the opportunities and risks of the coming payment configurations in the Affordable Care Act, including:
- Accountable care organizations (ACOs)
- Patient-centered medical homes
- Value-based purchasing
On March 4, 2013, the Commission issued a report and recommendations on how to reform the physician payment system in an effort to rein in health care costs and optimize outcomes for patients.