Providers don't see better quality under value-based payments

A new study in the Annals of Family Medicine finds most primary care providers think value-based payments negatively impact their work.

The study of over 400 primary care physicians in Sweden receiving performance-based payments showed that 70% of study participants reported a negative effect on their work. The value-based payments were negatively associated with illegitimate tasks and moral distress. Researchers defined illegitimate tasks as those beyond the scope of the provider's primary responsibilities.

And when providers experienced higher perceived levels of illegitimate tasks and moral distress, they did not see the benefits of value-based payment on quality of care, particularly at the organizational level.

"Our results should be viewed against the backdrop of an increase in unreasonable and unnecessary primary care physicians work over recent decades," researchers wrote in the study. "This added work has the effect of not only increasing the quantitative workload, but also created increased levels of moral distress among physicians who do not feel able to provide the quality of care they should be providing."

The study's findings also come at a time when physician burnout is still extremely high. The American Medical Association reports a physician burnout rate of 48.2%, a significant drop from 62.8% reported in 2021 during the COVID-19 pandemic. However, the rate is still alarmingly high, as some healthcare experts call physician burnout an ongoing epidemic.

The study calls attention to an often overlooked aspect of value-based care and reimbursement: the clinician's experience.

The healthcare industry has expanded the goals of value-based care from the Triple Aim -- population health, care experiences and lower costs -- to the Quadruple Aim, which also encompasses clinician well-being. However, research suggests that value-based care models have yet to positively influence the clinician's experience, indicating a need to reimagine quality metrics and their incentives.

In an accompanying editorial, physicians from Grant Family Medicine in Ohio recommended "refocusing incentives to those that are impactful, time limited, low cost, and physician controlled."

"Otherwise, our fear is that the pay-for-performance models will continue to add administrative work to primary care clinicians that will further overburden the system with administrative care and unrecognized costs that further degrade primary care’s value to the medical care system," they explained.

They asserted that "[a]ll quality metrics are wrong," although some "could become useful" if healthcare leaders use a new lens to evaluate value-based payments and their influence on quality of care.

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.