Value-Based Purchasing: How Physicians Will Be Compensated in the Future

Barbara L. Jones
Published: Friday, May 10, 2013
Dr. Frank G. Opelka

Frank G. Opelka, MD

Frank G. Opelka, MD, is the executive vice president of Health Care and Medical Education Redesign for the Louisiana State University (LSU) System. He also serves as vice chancellor for Clinical Affairs and is a professor of Surgery at the LSU Health Sciences Center in New Orleans. With expertise in healthcare patient safety, quality improvement, and healthcare finance, and as a recognized national leader in patient-centric healthcare, Opelka has been involved at the national level in the design and implementation of the Affordable Care Act.

Opelka delivered the Ambrose-Reed Lecture at the 77th Annual Southeastern Section of the American Urological Association (SESAUA) meeting held in Williamsburg, Virginia. The Ambrose-Reed Lecture honors two pioneers in the field of health policy: Samuel S. Ambrose, MD, and Josiah F. Reed, Jr, MD, both of whom held leadership offices in the AUA.

Urologists in Cancer Care conducted an interview with Opelka to explore some of the health policy initiatives that will impact how physicians will be compensated in the future.

Urologists in Cancer Care: Dr Opelka, you stated that, in the general framework of the Affordable Care Act, performance measurement and performance improvement are linked “by design.” Can you comment on this as a goal of the Centers for Medicare & Medicaid Services (CMS)?

Dr Opelka: CMS is not just measuring for its own sake, but [is using performance measurements] in order to improve the quality, safety, and patient experience of care. CMS is challenging the profession to come up with performance measures that are actionable by physicians, hospitals, patients, and purchasers.

Physicians feel that performance measurement is important if the measures are important to patients, meaningful, actionable, relevant, feasible, clinical, and within practice workflows.

In your lecture title, you use the term “value-based purchasing.” Can you explain what that means?

The federal government or private corporations that purchase the healthcare or health insurance want to know that what they are purchasing has value—that they are getting a product that improves the quality of life of the patient and of overall healthcare. Or, if there is no way to improve it, that it at least provides the patient with all the relief he or she can potentially get in their care system.

How does the concept of “resource appropriateness” apply to the purchase of healthcare or to physicians who are involved in the delivery of healthcare?

Of all areas of performance measurement, resource use, or appropriateness, is one of the most complex and difficult. It is really quite easy to say that you have a structural measure that says you’re licensed and board-certified—a “check the box” measure. With “appropriateness” such as in prostate cancer, the clinician may be looking at four different diagnostic tests, of which perhaps three are absolutely appropriate, but the fourth one is questionable; it is a waste of resources to administer the fourth one. With surgeons, we have found that appropriateness lives on a scale; it is not black and white. But there are times when we order diagnostics or other tests that are of limited overall value. Today, we cannot afford that.

What do you mean when you say that the Measures Application Partnership is not driven by measuring physicians, but instead by measuring an outcome for a patient?

The Partnership is part of the Affordable Care Act, and the goal or function of the Partnership is to look at the National Quality Strategy (NQS), which is patient-centric, and to try to provide measures that optimize NQS. Using cancer care as an example, instead of just measuring one moment in care, such as one office visit, the Partnership is more interested in the overall outcome of cancer care for that patient over a continuum of, say, three months, six months, or one year, regardless of providers.

What does the patient expect at the end of a given time period? Instead of talking about whether the patient got antibiotics in a timely fashion around the time of surgery, we want to ensure the patient had a surgery that resulted in the lowest possible level of complications and the best and most optimal quality of life subsequent to the surgery.

In light of the new “value-based” payment approaches, would you say that fee-for-service is dead?

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