WASHINGTON – Between a growing trend of consumers becoming more cost conscious in health care and a lack of differentiating quality measures, gastroenterologists could be staring at price as the key competitive point that determines market share.
This was the warning Francois de Brantes, executive director of the consultancy Health Care Incentives Improvement Institute, told attendees at the American Gastroenterological Association’s Partners in Quality 2016 conference.
On the side of quality, he noted that what is passing for quality measures, both in the current Physician Quality Reporting System and in the recently released consensus core quality measures developed in collaboration between the Centers for Medicare & Medicaid Services (CMS), America’s Health Insurance Plans, providers, and other stakeholders, will do very little to differentiate one physician from another.
And signs are pointing to that continuing as CMS shifts to paying for quality under the forthcoming Merit-Based Incentive Payment System and alternative payment models.
“Over the next several years, there are going to be coming from medical specialty societies and others, proposals to CMS around physician-based alternative payment models,” Mr. de Brantes said.
“I’ll bet you anything that most of them are going to be procedure centric because they think Medicare price doesn’t matter, it’s fixed,” he continued. “But what you do there will have a spill-over effect. They’re going to have a tendency to be very tightly defined around a few services, a few things that most physicians feel are under their control. The more you do that, the more you are going into a price war.”
He called on gastroenterologists to be more proactive in creating quality measures that are truly based on outcomes and can measure the skill of practicing physicians.
“The less variation there is that is a function of the quality of care being given and the more the variation that’s left is really about differences in prices, the more you are headed straight into a price war,” Mr. de Brantes said. “The more variability there is because of skills in managing patients and how the management of that condition evolves over time, the more opportunity there is to really grab a much bigger of slice of the pie.”
And with pricing becoming a more important piece of the health care decision-making process, gastroenterologists will need to be doing more to show value for what patients are paying for and they will have to be a lot more transparent in providing pricing information up front.
“The point is when it is your money you do make different decisions and transparency becomes the condition for doing business,” Mr. de Brantes said. “It’s not an option and I am not saying it’s going to happen tomorrow, but we are seeing enough signs of enough providers and enough specialties taking a proactive role because the pressure is mounting.”
That pressure is coming from the growing number of high-deductable health care plans that are putting more individual dollars in play, forcing patients to be more aware of their own medical expenses and making decisions based on them.
“This isn’t fantasy. It is people’s money,” he said “It’s not the third party payer’s coffers that are being pulled into this. It is the individual family’s income, 20% of which is now being used if you have a couple of chronic conditions, 20% of your income is being used for health care expenses. So there is a different demand. There’s a different expectation.”
And with that focus coming from consumers on price, he said that added an even stronger incentive for gastroenterologists to step up and develop meaningful quality measures that will add a level of distinction within the market.
“You better be figuring out measures that truly differentiate performance in a meaningful way to you and a meaningful way to consumers,” he said “If everyone looks the same in quality, then I know how I make my decision.”