J. M. Linson1, J. W. Dennis1, E. Lerner1, M. Nussbaum1, J. Tepas1 1University Of Florida College Of Medicine,Surgery,JACKSONVILLE, FL, USA
Introduction:
The shift from Fee- For-Service (FFS) to value and quality based payment has stimulated multiple alternative payment models (APM) that include the Medicare ‘Shared Savings Program (SSP),’ ‘Pay for Performance (P4P),’ ‘Comprehensive Care Payments (CCP),’ and ‘Episode of Care/Bundled Payment (EOC/BP)’. The Department of Health and Human Services (HHS) has declared its goal to tie 30% of Medicare payments to alternative payment models by the end of 2016, and 50% by the end of 2018. Recently enacted legislation repealing the sustainable growth rate (SGR) intends to shift to >75% of reimbursement to APM. Little is currently known about the perception of this among General Surgery residents, who will inherit a system in flux upon completion of their training.
Methods:
An electronic survey was distributed to American General Surgery residents to assess their understanding and perception of these alternative models. Using Likert scale responses, surgical autonomy, patient satisfaction, coordination of care, control of costs, and surgical outcomes were evaluated with respect to these reimbursement models. Model types were compared by level of understanding and perception of impact on key areas of surgical practice.
Results:
255 surveys were distributed individually via program coordinators, and one link was distributed via the Association of Program Directors in Surgery list-serve, yielding a return of 183 responses. FFS and P4P were best known, with >75% of respondents reporting at least moderate familiarity. BP/EOC was at least moderately familiar to 62% of respondents. Conversely, 63.2% indicated limited familiarity with CAP. 60.2% were slightly or not at all familiar with CCP. 71% were either slightly or not at all familiar with SSP. Analysis of impact on surgical practice demonstrated consensus regarding anticipated effect on surgical autonomy and cost control (table). None of the models were seen as improving patient satisfaction. P4P was anticipated to improve outcome by 47.2% of respondents. A need for more education about the new healthcare reimbursement models was indicated by 95.1% of respondents.
Conclusion:
Most residents have limited familiarity with FFS, P4P and BP/EOC. Most also recognized the trade-off between surgical autonomy and cost control. Only FFS was perceived to have a positive effect on autonomy, while all alternative models had a perceived negative effect. Only P4P was perceived to have a positive impact on surgical outcomes by a majority of respondents. An overwhelming majority articulated need for more education in this area and a role in developing and evaluating these alternative models.
