There is a move away from the charge based, discounted managed care revenue model. And, that is a good thing. Since 1986, discounting fees with the result of minimum new patient steering has been the order of the day in Dallas-Fort Worth. The emerging “Big” new idea is “value based” compensation. Today, both the government and insurance industry are advocating “value based” provider payments. The Management Service Organization (MSO) leading Physicians Direct Access (PDA) is preparing for an institutional and economic shift to this payment method. These big words, big thoughts, and even bigger implementation questions…challenge the MSO to develop a “best method” to accomplish this objective. The final product of a new compensation system must deliver equity for providers, payors, and patients. And, no one is there yet, i.e., this is a work in process.
Hear this: The MSO leading PDA believes the transition to a value-based payment system can and will be ultimately successfully accomplished. That conviction is the start of a “buy-in” process that is predicated with the admonition that the time-to-complete such a transition is not clear. Still, it is important not to wait on anything. PDA has to start this transition to “Value Based” payments. Such a systemic change of economic functionality and practitioner productivity is now our business.
It is believed that a significant financial incentive exists for innovative physicians who wish to become managers of their own fiscal future. What is here is the chance to opportunistically capitalize on what is a genuine sea change of how physicians make money.
MSO management has had success working in an environment of risk-reward. Past experience suggests that risk-reward contracting is related directly to the transition to “Value Based” compensation. What has also been revealed is that serving a clinically integrated network or ACO is just another professional investment in learning the steps to this new technology of payment for services. So, the MSO management has the reference of past experience with small physician group participation in “risk-reward” contracts, and is now awaiting instruction on how the specific details of the Tenet CIO organization, Physician Performance Network of North Texas will unfold. As an organization and culture, we are moving forward.
There are definitely new roles emerging for the independent physician. For example, one can produce in one or more CIO structures, utilize the traditional PDA/IPA, seek “concierge agreements”, serve retail store medicine, and also manage the work of other producers in a physician organized delivery (POD) system.
Likely, most physicians are for now staying on the same track of discounted fee-for-service as long as they can. We embrace those important member practitioners. Their credentialing and managed care contracts will continue to be skillfully managed by PDA. But, this invitation is for the restless, inquisitive…self-directed business-minded physician and/or clinician. If you would like to learn more about the “Physician Ventures” model, a briefing will be announced in the next fifteen days.
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