There is a renewed push for value-based care as the number of COVID-19 cases ticks down nationally and federal funding to support healthcare organizations wanes.
Insurers and health systems are working together to develop value-based contracts where providers take on more risk for outcomes with the goal of eliminating wasteful spending. Health tech companies have also become part of the equation, developing systems to gather data, automate processes and enable virtual care.
Value-based care seems like a winning proposition for a healthcare system where spending is already high and patients who need lower out-of-pocket costs. But what about surgeons and ASCs?
If surgeons could simply practice medicine and do what's best for patients, it would be an easy sell. However, that's not the case. Value-based care requires much more data-gathering and reporting than fee-for-service contracts, increasing the administrative burden on physicians.
"The devaluing of the physician with extensive clinical experience and wisdom because of increasing administrative burden to treat our patients, thereby causing early burnout, is the biggest danger to our profession today," said James Bradley, MD, an orthopedic surgeon at the University of Pittsburgh Medical Center.
With a physician shortage looming, the healthcare system can't afford to lose many more. Private practice and ASC ownership can reinvigorate surgeons and add value to the healthcare system, since surgery centers are often high quality, low cost settings for care.
"Medicine is becoming increasingly sensitive to value, and there is no question that when redesign of practices comes about to reduce cost, the least value-added portion of healthcare is administration," said Robert Szabo, MD, an orthopedic surgeon at University of California-Davis Health. "Private practice cuts out the multiple levels of administration that exist in big healthcare systems."
It makes sense for insurers to value ASCs highly, but many surgery centers are still forced to operate on razor-thin margins because rate increases aren't keeping pace with inflation. Surgery centers, as small businesses, often don't have access to the same data-gathering and reporting capabilities. The challenge next for insurers will be finding ways to support independent healthcare providers through the value-based transition in ways that won't add more administrative burden to the average patient interaction.