Advocates: Payment Method Conflicts With Doctor-Patient Relationship
A group of stakeholders met Monday for the fifth time to discuss how the state will use a federal grant to transform the way doctors and providers will be paid for their services. Two advocates say the payment method they chose will get in the way of the doctor-patient relationship.
With a $2.8 million grant from the Centers for Medicare and Medicaid Services, a group of about 17 people — mostly from Gov. Dannel P. Malloy’s administration — have been meeting monthly in the state Capitol to discuss exactly how doctors will be paid and what quality measures they must meet in order to receive payment.
State Healthcare Advocate Victoria Veltri, who led the discussion Monday, said there’s been no firm decision on exactly which payment method will be employed by most health plans in the state. She said the job of the group is to make a recommendation to the governor’s office. The governor, possibly the one elected in 2014, will ultimately decide which payment method to use for all the state plans from private commercial insurance to the state employees health plan to Medicaid.
“The payment mechanism is a way to implement the care delivery model,” Veltri said.
But advocates like Sheldon Toubman of New Haven Legal Assistance and Ellen Andrews of the Connecticut Health Policy Project turned purple Monday when they saw handouts detailing plans to move 80 percent of the states population into a payment model they say “rewards doctors for denying care.”
Documents handed out at the meeting Monday show that a “Pay for Performance” model — in which doctors get a bonus payment based on whether their patients get healthy — will be phased out in the next five years. Instead, the state contemplates moving to a “Total Cost of Care” payment method where the risk is assumed by doctors who will decide what care is delivered to their patients. The state will still be in charge of developing the quality care metrics.
Veltri maintained that the goal of the “State Health Care Innovation Planning Team” is not to design a plan that allows for “improper denials of care.” She said the group is trying to do the exact opposite by incentivizing care based on a “scorecard” of quality metrics it will design.
But Toubman and Andrews weren’t convinced the group is headed in the right direction.
“I think the Connecticut public would be shocked to learn a small number of people working for the Malloy administration have been cooking up — without any input from consumers — a scheme to put the government between doctors and their patients,” Toubman said.
The “Total Cost of Care” model, according to Toubman, rewards doctors for restricting access to care. He said the model pays doctors extra if they save money on their patients’ health care costs. That means doctors have an added incentive not to tell their patient about a specific procedure because it will cause them to lose money.
Veltri warned that it’s premature to say decisions have been made.
“We’re just mixing the batter, the cake isn’t even in the oven yet,” Veltri said.
The quality care metrics task force “is really the meat of the whole thing,” she added.
But not all the stakeholders are at the table, according to Toubman and Andrews. Consumers and hospitals are missing. And the group hasn’t been vocal about the method it’s leaning toward using when it seeks input from outside groups.
“So when they got input, the input was meaningless to the proposal they were actually told about,” Toubman said. “They were asked about access issues in general, not access issues in their model.”
Veltri, whose office deals with denial of service complaints on a daily basis, said there’s no question that the state always has to guard against improper denial of service. She said she doesn’t share the view of the payment model held by Toubman and Andrews and said she was willing to speak with them about it, but just not in front of a reporter.
Toubman maintained this payment method fundamentally changes things and puts the government of the state of Connecticut in between patients and their doctors. He said that even if the state employs specific quality measures, doctors may do well on those. But Toubman said that in order to save money, doctors will cut back home-care hours, prescribe generic medications, offer a lower level of mental health treatment to children, restrict access to physical therapy, or simply fail to tell a patient about a treatment.
The state started out by shifting the risk to the HMOs, Andrews said. And when that didn’t work they decided to shift it to the consumers, she said, and when that didn’t work the only ones left to carry the risk were the providers.
“There’s no evidence this works,” she said. “They want to take this questionable model and put it on everybody in a place that’s really not ready for it.”
Veltri said there’s going to be plenty of time for stakeholders and consumers to contribute to the conversation. The conversation about what quality metrics should be used and included in the payment model will continue through March 2014, according to documents handed out at Monday’s meeting.
In the meantime, a group of stakeholders will be formed to refine those metrics.