News & Commentary

Docs Still Prefer Volume Over Value


That coronation of value-based care that everybody is talking about—it may need to be delayed, judging by the results of a physician survey by Deloitte earlier this year.

Deloitte’s “2016 Survey of U.S. Physicians” asked 600 primary care and specialty physicians how far along they are in transitioning from a volume- to a value-based system of care.

Only 3% of health systems and medical groups provide more than half of all care under value-based contracts.

The survey’s executive summary quotes Mark Twain: “I am in favor of progress; it’s change I don’t like.” Many physicians still prefer fee for service. In 2016, 40% of all physicians ranked fee for service as their first choice; 28%, ranked it second. The findings are not much different from those in Deloitte’s 2014 survey, in which 47% of physicians ranked fee for service as their first choice and 27% ranked it second.

Which is not to say that physicians can never be lured into value-based care. Incentives are most effective if they go directly to the physician, rather than the medical group.

Geisinger, for instance, with its employed-physician model and eye on cost and quality control, uses an 80/20 compensation model, with the 20% being based on physician performance.

“Since instituting this compensation structure in 2006, Geisinger has seen improved health outcomes and lower costs for 18 common treatment interventions for conditions such as congestive heart failure,” says the survey.

According to Deloitte, that is the way to go: Tie 20% of doctor compensation to performance goals. Anything less, and there is no real incentive to perform. Also, health plans should equip doctors with the right tools. Physicians want detailed information on their performance and on doctors to whom they may refer patients.

Health plans should also help physicians invest in technology as a way of connecting and integrating tools, and the information they receive should be timely, reliable, and actionable.

“Our survey results suggest that many physicians distrust the data they receive or find it difficult to integrate that information into their daily practice,” says Deloitte. Information, it says, is more likely to be used if it is available when needed and accompanied by reliable benchmarks.

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