A survey by Kaiser Family Foundation and the Commonwealth Fund asked about 1600 primary care physicians and 525 nurse practitioners or physician assistants their views on reimbursement and quality measurement issues. (KFF Report) About a third of physicians are still paid on a purely fee-for-service basis, while the remainder either receive captivated payments, are on salary or have some combination of these methods. NPs and Pas are almost exclusively on a non-fee-for-service basis. 55% of physicians say they get some payment related to quality performance, as do a third of the NPs or PAs. 29% of primary care doctors participate in either a Medicare or private insurance ACO and about the same percent are in a practice that qualifies as a medical home. Among all primary care physicians, ACOs are viewed as having a negative or uncertain effect by 64% and only 14% view these as positive; although among doctors in an ACO, that rises to 30%. For medical homes, among all doctors 33% perceive them as positive, and 43% in a medical home do so.
Almost 25% don’t accept Medicare. 17% of the physicians were in a practice that consolidated with was acquired by another practice, a hospital or another health organization in the last year. About half of physicians and a fourth of PAs and NPs say they are considering early retirement due to recent health care trends. About half the doctors and two-thirds of the ancillary practitioners said health information technology had a positive impact on care delivery. Only 12% said the hospital readmissions penalties had a positive effect on their delivery of care. 50% of all primary care physicians and 27% of NPs and PAs think using quality measures to assess performance has a negative impact on care delivery and only a small minority of each see a positive effect. Only 29% of doctors see more use of NPs and PAs as positive, although 40% of physicians who have such professionals in their practice do, while 88% of these professionals see more use of them as positive (what’s up with the other 12%?). Primary care providers are substantially more satisfied with private insurer reimbursement than that from either Medicare or Medicaid and they view the private plans as easier to deal with in regard to administration of reimbursement. All-in-all, not exactly good news regarding the satisfaction of the key providers in the health system or their reaction to all the wonderful initiatives reform has encouraged.