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Related Concept Videos

Introduction To Health Care Delivery System01:18

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Optimizing Physician Payment for a Single-Payer Healthcare System.

Stephen B Kemble1, James G Kahn2

  • 1Medicine and Psychiatry, University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, USA.

International Journal of Social Determinants of Health and Health Services
|May 25, 2023
PubMed
Summary

Physician payment reform is needed. A proposed "Fee-for-Time" system offers a simpler, fairer, and more objective alternative to current fee-for-service and value-based payment models.

Keywords:
capitationfee-for-servicephysician paymentsingle-payer

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Area of Science:

  • Health Economics
  • Medical Practice Management
  • Healthcare Policy

Background:

  • Current physician payment models in the U.S. include fee-for-service (FFS), capitation, resource-based relative value scale (RBRVS), and value-based payments (VBP).
  • These systems present limitations, such as incentivizing excessive or insufficient care, inequitable compensation across specialties, and administrative burdens.
  • Existing models can negatively impact physician morale and distract from patient care.

Purpose of the Study:

  • To propose and describe an alternative physician payment system called
  • Fee-for-Time
  • as a potential solution for healthcare financing reform.
  • To analyze the shortcomings of current payment methodologies, including FFS, RBRVS, and VBP.
  • To advocate for a payment system that is simpler, more objective, and fairer to physicians.

Main Methods:

  • The study proposes a
  • Fee-for-Time
  • payment model where physicians are compensated at an hourly rate.
  • This rate is determined by factors such as years of necessary training and time spent on service delivery and documentation.
  • The proposal is presented as a component of broader healthcare financing reform, potentially integrated with single-payer systems.

Main Results:

  • The
  • Fee-for-Time
  • model addresses the overvaluation of procedures and undervaluation of cognitive services inherent in RBRVS.
  • It mitigates the risk-shifting and potential for gaming performance metrics associated with VBP.
  • The proposed system aims to reduce administrative costs and improve physician motivation.

Conclusions:

  • The
  • Fee-for-Time
  • payment system offers a more objective and incentive-neutral approach compared to current models.
  • Its implementation, potentially combined with single-payer financing, could lead to a fairer, simpler, and more cost-effective healthcare system.
  • This model addresses key administrative and motivational challenges faced by independent physicians.