Value Based Healthcare Competition

[mcgvbc]

Hi Everyone!

We are so excited to announce MCG's third annual Value Based Healthcare Case Competition! Value deficits are common in the healthcare systems we will one day work in. As future leaders in healthcare, we must play a key role in recognizing and addressing these value deficits to in turn create more equity in healthcare access and outcomes. The goals of this competition are to present the concepts of value-based healthcare provision and emphasize practical applications by challenging you to address real-world problems in the healthcare field.

We are recruiting schools from different health professions throughout the US to join us for the national competition! This is a great opportunity for students to get involved and get leadership opportunities, be involved with research, and more. Please click the link or scan the QR code for more information.

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[jstwannagraduaaate!!!]

Value based= excuse to not pay physicians for their time, no thanks

 

[voxveritatisetlucis]

Doesn’t value based healthcare encourage physicians to not operate on people who are more likely to have a bad outcome?

 

[srirachamayonnaise]

Doesn’t value based healthcare encourage physicians to not operate on people who are more likely to have a bad outcome?

Literally some wokism crap.

 

[grist]

Doesn’t value based healthcare encourage physicians to not operate on people who are more likely to have a bad outcome?

Outcomes are risk adjusted in most value-based schemes.

 

[srirachamayonnaise]

Outcomes are risk adjusted in most value-based schemes.

I don't know what they are talking about when they have a COMPETITION??! Value-based healthcare is just fancy term for payment based on outcome. How can you have a competition about that?? Like, oh who can design a better value-based healthcare payment scheme?! It's conjured up by PE firms to keep doctors on their toes and screw them on their compensation. It's just another way Wall Street BS invades medicine.

 

[dantt]

we are our own worse enemy

 

[Lem0nz]

I don't know what they are talking about when they have a COMPETITION??! Value-based healthcare is just fancy term for payment based on outcome. How can you have a competition about that?? Like, oh who can design a better value-based healthcare payment scheme?! It's conjured up by PE firms to keep doctors on their toes and screw them on their compensation. It's just another way Wall Street BS invades medicine.

No it isn't.

That said, it is not particularly of interest for non-administration based physicians in the current market in America. The reality is that if you are employed or under fee for service (which encompasses like... almost all of us) you are paid a lump sum under fee for service or paid $X/RVU and the value of care you provide is not relevant. You may have a quality bonus attached to value (meet certain LOS metrics or complication metrics get a flat time bonus of X) but that dollar amount is usually nothing close to your salary or productivity (and is usually not relevant in private practice fee for service).

However, in our lifetimes and the lifetimes of the medical students who are just going into the system the chances of a switch to more capitated models is pretty real. Not guaranteed, but it could absolutely happen and it would likely herald a pretty dramatic shift in how things get reimbursed. It doesn't mean you have to participate in this sort of stuff, but it is worth paying attention. If you want to run a department one day or be in administration at all it will matter a lot.

Value is also not just defined by outcomes. There are lots of things you can do that make a big difference. Am surgeon so surgeon mind go brr and I can only relate to things about surgery but using the same instruments for each case, getting rid of instruments you don't need, using instruments that achieve the same goal but are cheaper, using more expensive instruments that reliably save time and have better outcomes and reduce take-backs... all of these things are important. Allows for iterative intelligent changes to your practice to keep people out of the hospital, home, and happy. It does not mean avoid risk (it doesn't mean that at all...).

I think @operaman is the one who brings it up all the time, but the quality of your surgery as a surgeon is tied directly to your quality of life. If you can perform a surgery faster, safer, cheaper than the next guy and ensure your patients have less or no complications and stay out of the hospital (or are in the hospital less time) then you get paid more money, get more patient referrals and have more volume, spend less time rounding and seeing patients in the ER or doing operative take backs and ultimately you're at home with your family doing non-medicine stuff (with more $$$ as a kicker). And I guarantee if you're the surgeon doing cases for 1/2 of the cost as the other surgeons in your institution you are FAR more likely to get new equipment, dedicated support staff, etc.

It is not just to enrich private equity. Just another tool. You can ignore all of that stuff if you want but in my opinion its very much worth paying attention to, if not learning and embracing some of the tenants.

 

[jstwannagraduaaate!!!]

No it isn't.

That said, it is not particularly of interest for non-administration based physicians in the current market in America. The reality is that if you are employed or under fee for service (which encompasses like... almost all of us) you are paid a lump sum under fee for service or paid $X/RVU and the value of care you provide is not relevant. You may have a quality bonus attached to value (meet certain LOS metrics or complication metrics get a flat time bonus of X) but that dollar amount is usually nothing close to your salary or productivity (and is usually not relevant in private practice fee for service).

However, in our lifetimes and the lifetimes of the medical students who are just going into the system the chances of a switch to more capitated models is pretty real. Not guaranteed, but it could absolutely happen and it would likely herald a pretty dramatic shift in how things get reimbursed. It doesn't mean you have to participate in this sort of stuff, but it is worth paying attention. If you want to run a department one day or be in administration at all it will matter a lot.

Value is also not just defined by outcomes. There are lots of things you can do that make a big difference. Am surgeon so surgeon mind go brr and I can only relate to things about surgery but using the same instruments for each case, getting rid of instruments you don't need, using instruments that achieve the same goal but are cheaper, using more expensive instruments that reliably save time and have better outcomes and reduce take-backs... all of these things are important. Allows for iterative intelligent changes to your practice to keep people out of the hospital, home, and happy. It does not mean avoid risk (it doesn't mean that at all...).

I think @operaman is the one who brings it up all the time, but the quality of your surgery as a surgeon is tied directly to your quality of life. If you can perform a surgery faster, safer, cheaper than the next guy and ensure your patients have less or no complications and stay out of the hospital (or are in the hospital less time) then you get paid more money, get more patient referrals and have more volume, spend less time rounding and seeing patients in the ER or doing operative take backs and ultimately you're at home with your family doing non-medicine stuff (with more $$$ as a kicker). And I guarantee if you're the surgeon doing cases for 1/2 of the cost as the other surgeons in your institution you are FAR more likely to get new equipment, dedicated support staff, etc.

It is not just to enrich private equity. Just another tool. You can ignore all of that stuff if you want but in my opinion its very much worth paying attention to, if not learning and embracing some of the tenants.

But for those of us interested in private practice, this payer model is just another hoop to jump through. I can see why psychiatry is becoming more competitive; cash only and not dealing with this headache

 

[Lem0nz]

But for those of us interested in private practice, this payer model is just another hoop to jump through. I can see why psychiatry is becoming more competitive; cash only and not dealing with this headache

Perhaps but on the global level it isn't a hoop you will control if the country moves that direction. We can all cite thousands of reasons why healthcare costs continue to increase in America but it doesn't change that underlying statement: healthcare costs are increasing in America and are likely to continue to do so. Hospital systems, private insurance, public insurance, and the government have to tackle that problem. We can either participate in the conversation and try to minimize the damage and maximize the benefit to us or we can sit back and accept what happens with no say.

Setting aside reimbursement, I highlighted about 5 very major reasons why it would apply to your individual practice as well that are worth consideration.

 

[VA Hopeful Dr]

Perhaps but on the global level it isn't a hoop you will control if the country moves that direction. We can all cite thousands of reasons why healthcare costs continue to increase in America but it doesn't change that underlying statement: healthcare costs are increasing in America and are likely to continue to do so. Hospital systems, private insurance, public insurance, and the government have to tackle that problem. We can either participate in the conversation and try to minimize the damage and maximize the benefit to us or we can sit back and accept what happens with no say.

Setting aside reimbursement, I highlighted about 5 very major reasons why it would apply to your individual practice as well that are worth consideration.

This.

Value based reimbursement is coming (and already somewhat here). We can either try and work with it to maximum benefit or we can ignore it and pay the price.

 

[jstwannagraduaaate!!!]

This.

Value based reimbursement is coming (and already somewhat here). We can either try and work with it to maximum benefit or we can ignore it and pay the price.

I really don't get this mindset. Mechanics and HVACs can charge a fee for their service, whether or not the thing breaks in 3-4 months down the line they still get paid. Medicine seems to be the only field where those in it advocate against said field's interest.

 

[VA Hopeful Dr]

I really don't get this mindset. Mechanics and HVACs can charge a fee for their service, whether or not the thing breaks in 3-4 months down the line they still get paid. Medicine seems to be the only field where those in it advocate against said field's interest.

I think you misunderstand my post. It wasn't meant to be pro- or anti-value based reimbursement. It was a statement of how the world is and our two options of dealing with it.

 

[operaman]

I find value in healthcare a fascinating topic and don’t see it as adversarial as others do.

Capitated payments to docs have been around for a long time. Many surgical procedure codes include a global period which means that one fee covers your surgeons fee, pre op H&P, post op care and follow up visits for 90 days. This has been around for a long time. Obviously my goal is to minimize complications and follow up care needs.

So far the broader value based payment reforms have been aimed more at the large institutional level, less at the solo MD. But it will spread into more areas. In many ways this is simply returning some market forces to healthcare. If we were paid directly by all our patients, I’m sure they would have many questions about value and cost. Our current system is the anomaly where we pretend money is limitless and magical but intellectually we must know that isn’t sustainable. Personally I just need to last 20-25 more years.

The other interesting thing is that solo practice docs have been value conscious for decades or more. As someone toying with the idea of going solo private in a couple years, I’m becoming well acquainted with costs and I have a big interest in keeping costs low. I’m exploring different workflows and setups to minimize my costs while still allowing me to practice high level care. Sure a brand new top tier scope tower would be nice, but is it $150k nice? Can I see what I need to see with something less? Etc etc. lots of value based decisions and thinking. It’s much easier to spend institutional money than to spend my own money!

 

[ChordaEpiphany]

I really don't get this mindset. Mechanics and HVACs can charge a fee for their service, whether or not the thing breaks in 3-4 months down the line they still get paid. Medicine seems to be the only field where those in it advocate against said field's interest.

It's almost insane when you think about how much the profession basically advocates against itself. It should be a major talking point when it comes to getting high reimbursement, because the actions taken by physicians are universally vetted and bring value to society. We should be out there demanding that other fields, particularly other fields that accept government payment, demonstrate their worth explicitly.

Doctors not only take a hit relative to other fields by requiring that all interventions are efficacious, but also take a hit by being the ones who take time out of the cash-flow aspect of their profession to actually do the studies.

Imagine if the finance profession did the same. They study whether or not certain investment vehicles or management strategies resulted in better outcomes for the client, and a financial advisor would be liable if they mismanaged the funds even slightly. Like, imagine if before you bought into a mutual fund brokerages were obligated to suggest you equivalent ETFs with lower expense ratios. Then imagine that if a financial advisor recommended asset classes that yield high fees for little return when other suitable alternatives were available, you could sue them into oblivion and they'd lose their license. The whole finance world would collapse if we held them to the standard of physicians.

Tech companies can launch untested products that spike depression and anxiety rates (literally on purpose) in hundreds of millions of people, and they can make trillions off of it, but if a study showed that 1 in 1000 people receiving Medical Intervention X maybe gets a heart arrhythmia then the whole thing is in jeopardy.

I'm proud to be part of a profession that holds itself to a high standard, but we can't be the only professionals doing this. We're in the process of getting walked over, and we're tying the boots for our overlords to do it.

 

[Sleepingdoc]

So its value to insurance companies. Just means that you support being paid less.
Primary care is much different than a surgical procedure BTW...
All companies are looking for suckers who are willing to work more to get paid less. This is just another excuse.

 

[srirachamayonnaise]

It's almost insane when you think about how much the profession basically advocates against itself. It should be a major talking point when it comes to getting high reimbursement, because the actions taken by physicians are universally vetted and bring value to society. We should be out there demanding that other fields, particularly other fields that accept government payment, demonstrate their worth explicitly.

Doctors not only take a hit relative to other fields by requiring that all interventions are efficacious, but also take a hit by being the ones who take time out of the cash-flow aspect of their profession to actually do the studies.

Imagine if the finance profession did the same. They study whether or not certain investment vehicles or management strategies resulted in better outcomes for the client, and a financial advisor would be liable if they mismanaged the funds even slightly. Like, imagine if before you bought into a mutual fund brokerages were obligated to suggest you equivalent ETFs with lower expense ratios. Then imagine that if a financial advisor recommended asset classes that yield high fees for little return when other suitable alternatives were available, you could sue them into oblivion and they'd lose their license. The whole finance world would collapse if we held them to the standard of physicians.

Tech companies can launch untested products that spike depression and anxiety rates (literally on purpose) in hundreds of millions of people, and they can make trillions off of it, but if a study showed that 1 in 1000 people receiving Medical Intervention X maybe gets a heart arrhythmia then the whole thing is in jeopardy.

I'm proud to be part of a profession that holds itself to a high standard, but we can't be the only professionals doing this. We're in the process of getting walked over, and we're tying the boots for our overlords to do it.

The worst part is that young medical students have to be indoctrinated at the beginning of their career that it’s an admirable way of getting compensated. Hence, you have this totally ridiculous annual competition. Way to go to take advantage of someone’s innocence.

 

[VA Hopeful Dr]

I'm proud to be part of a profession that holds itself to a high standard, but we can't be the only professionals doing this. We're in the process of getting walked over, and we're tying the boots for our overlords to do it.

We're not.

That being said, we're also in the somewhat unique position of being completely divorced from our patients (clients to everyone else) financially speaking. If there was comprehensive legal insurance with a large part of it being from the government and people used lawyers as much as they do doctors, we'd see similar things in that profession. As the old saying goes: he pays the piper calls the tune.

 

[jstwannagraduaaate!!!]

We're not.

That being said, we're also in the somewhat unique position of being completely divorced from our patients (clients to everyone else) financially speaking. If there was comprehensive legal insurance with a large part of it being from the government and people used lawyers as much as they do doctors, we'd see similar things in that profession. As the old saying goes: he pays the piper calls the tune.

Premiums and copays for patients go up every year and physician reimbursement declines, yet docs still take said insurance. Fields like cash only psyc, direct PCP, and cash-only surg elective procedures/derm seem to be the only ones adjusting to being walked over. I'm just a med student so my perspective is probably much different than those in practice. But, I have seen the vast majority of my classmates openly saying they are ok with working for a mega corp hospital chain because they are "scared of the risk" of building your practice. Fear is what keeps the worker bees inline and enriches those who are in control.

 

[VA Hopeful Dr]

Premiums and copays for patients go up every year and physician reimbursement declines, yet docs still take said insurance. Fields like cash only psyc, direct PCP, and cash-only surg elective procedures/derm seem to be the only ones adjusting to being walked over. I'm just a med student so my perspective is probably much different than those in practice. But, I have seen the vast majority of my classmates openly saying they are ok with working for a mega corp hospital chain because they are "scared of the risk" of building your practice. Fear is what keeps the worker bees inline and enriches those who are in control.

That and the money is WAY better.

 

[hamstergang]

Premiums and copays for patients go up every year and physician reimbursement declines

There's some debate around that:

Everyone says physician compensation is going down…. but medscape shows 29% increase since 2015?

https://www.prnewswire.com/news-releases/medscapes-2022-physician-compensation-report-physician-salary-rebound-but-gender-and-racial-gaps-persist-301526112.html Is this as simple as self-selection bias regarding which doctors choose to participate?

forums.studentdoctor.net

 

[grist]

There's some debate around that:

Everyone says physician compensation is going down…. but medscape shows 29% increase since 2015?

https://www.prnewswire.com/news-releases/medscapes-2022-physician-compensation-report-physician-salary-rebound-but-gender-and-racial-gaps-persist-301526112.html Is this as simple as self-selection bias regarding which doctors choose to participate?

forums.studentdoctor.net

29% increase since 2015 is just barely above inflation over that time period (25%)

 

[hamstergang]

29% increase since 2015 is just barely above inflation over that time period (25%)

When the claim is that our reimbursements are declining, even a little above inflation serves as a decent counter.

 

[grist]

When the claim is that our reimbursements are declining, even a little above inflation serves as a decent counter.

I disagree. Reimbursements across the board are cut year after year, meaning physicians have to see more patients and do more procedures to maintain salary. I imagine many people would consider working harder for the same pay to constitute a paycut.

 

[hamstergang]

I disagree. Reimbursements across the board are cut year after year, meaning physicians have to see more patients and do more procedures to maintain salary. I imagine many people would consider working harder for the same pay to constitute a paycut.

I don't think it's worth just repeating that thread in this one. I was just pointing out that it's not so clear that things are as terrible and worsening as was claimed, and we're not mindless corporate sheep for feeling differently.