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How do Primary Care Providers View ACA Payments & Delivery Models?

New primary care payment and delivery models have emerged in recent years to improve patient outcomes and lower health care costs. Many of these changes affect the way health care is organized, delivered, and financed and these changes have been strengthened or accelerated by the Affordable Care Act (ACA). Some examples of changes include the increased use of health information technology (HIT), a move toward team-based care and using non-physician clinicians, an effort to better coordinate care through medical homes and accountable care organizations, and the introduction of financial incentives and quality metrics to determine how providers are paid.

The Commonwealth Fund and The Kaiser Family Foundation surveyed primary care providers—physicians, nurse practitioners, and physician assistants—about their experiences with and reactions to recent changes in health care delivery and payment. Providers’ experiences with new models of care and changes to the health care system received mixed reviews. Unsurprisingly, performance assessments and financial penalties tied to patients’ outcomes are unpopular among providers. Many providers feel the increased use of quality metrics to assess provider performance is having a negative impact on quality of care. Physicians had very different views from nurse practitioners and physician assistants about the use of nonphysician clinicians in primary care; nearly nine of 10 (88%) nurse practitioners and physician assistants viewed this change positively, while only about one of three physicians (29%) agreed. However, this view largely depended on whether they have a nurse practitioner or physician assistant in their practice. Among physicians with any nurse practitioner or physician assistant staff, 40 percent reported a positive view of this trend.

Health technology received the most favorable reviews overall. The survey found that primary care providers generally accept the promise of HIT to improve quality of care, even if previous research shows they disliked the process of transitioning from paper based records.

These changes may have lasting effects on the medical field; nearly half of primary care physicians say that recent trends in health care are causing them to consider retiring earlier than planned.

Byline: Martha L. Sikes, MS, RPh, PA-C and Wendy Meltzer, MPH

Adapted from the official media report.

[image by Jfcherry]

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