Alternative Health-care Payment Models and their Affects on Doctors

Question: How do alternative health care payment models (i.e., models other than simple fee-for-service payment) affect physicians and physician practices in the United States?

1. Abstract

The project reported here, sponsored by the American Medical Association (AMA), aimed to describe the effects that alternative health care payment models (i.e., models other than fee-for-service payment) have on physicians and physician practices in the United States. These payment models included capitation, episode-based and bundled payment, shared savings, pay for performance, and retainer-based practice. Accountable care organizations and medical homes, which are two recently expanding practice and organizational models that frequently participate in one or more of these alternative payment models, were also included. Project findings are intended to help guide efforts by the AMA and other stakeholders to make improvements to current and future alternative payment programs and help physician practices succeed in these new payment models — i.e., to help practices simultaneously improve patient care, preserve or enhance physician professional satisfaction, satisfy multiple external stakeholders, and maintain economic viability as businesses. The report provides both findings and recommendations.

Key Findings

Payment Models Affect Practices

• Multiple practice leaders and market interviewees reported that their own practices or others in their markets were changing their organizational models in response to new payment models.
• Respondents perceived that alternative payment models have encouraged the development of team approaches to care management.
• Market observers and physician practices reported that global capitation and related shared savings models were changing relationships between primary care and subspecialist physicians.
• Physician practices reported making significant investments in their data management capabilities to track and improve performance in alternative payment models.
• The multiplicity of pay-for-performance and other incentive programs has created a heavy administrative burden for some physician practices.

Payment Models Affect Physicians

• The financial incentives applied to physician practices via alternative payment models were not simply "passed through" to individual physicians. Practice leaders described transforming certain practice-level financial incentives into internal nonfinancial incentives for individual physicians. Leaders acknowledged the presence of inconsistencies between financial and nonfinancial incentives. Alternative payment models had negligible effects on the aggregate income of individual physicians within the sample. Some physicians reported wanting to have their incomes more closely linked to quality and efficiency of care.
• Alternative payment models have not substantially changed how physicians delivered face-to-face patient care. Additional nonclinical work created significant discontent. Most physicians in practice leadership positions were optimistic and enthusiastic about alternative payment models, while most physicians not in leadership roles expressed at least some level of apprehension.

Recommendations

• To optimize the quantity and content of physician work under alternative payment models, ensure that physician practices have support and guidance.
• To improve the effectiveness of alternative payment models, address physicians' concerns about the operational details of these payment models.
• To help them succeed in alternative payment models, ensure that physician practices have data and resources for data management and analysis.
• To help physician practices respond constructively, harmonize key components of alternative payment models, especially performance measures.

Research: Rand Corp

PROPER MUSLIMS--DO SOMETHING!

By Cheri, the Non-PC Newsgirl

Whenever I hear Muslims speak of their barbaric brethren, I ONLY hear defense that they as Muslims are not like these barbaric people. I NEVER hear of how Muslims will take these people, kids, and at least try to teach them the correct way of the Koran, which is not to horribly kill innocents. I never hear the leaders of the Muslim community say we will do ALL we can to turn them into proper Muslims, and then go out and preach a better lecture on the true tenants of Islam than extremists.

When all I hear are Muslims defending themselves, as in singular, and not taking as a group, as in plural, I don’t have confidence that Muslims are even willing to try to stop this or even capable of it! For others who are fed up with the hostage takers and brutal slayings of innocents, they believe all Muslims are apart of it. I do not believe this, but I do believe proper Muslims are derelict in their duties to find their fringe Muslims and helping them avoid becoming extremists.

So please, in addition to defending yourselves, let the American people, the world, know you are doing something to stem the problem. Otherwise it does appear you’re almost encouraging this type of behavior. By remaining silent on this issue about the real reason your young Muslims are strapping bombs to their bodies or putting them in their back-packs to mangle and kill innocent runners, the problem gets worse.

These are your people and you have a responsibly to take these young Muslims in and show them the love they think they will get from extremists. If they're going to Syria, for Christ's sake, it seems apparent they're not getting the proper Muslim teachings from their own community and, more so, the love that the desperately need!

You’re more worried about defending the honor of Islam. Well think about it. How much more shame can be placed on Muslims and Islam than what's going on around the world now.

DO SOMETHING!

Screw Muslim Extremists

This is still America and we still have the U.S. Constitution where free speech, religion and press are tantamount to our way of life. We can't let these extremists, Isis or others, cow us with fear tactics to take away our way of life!

Soon after our Constitution was created, a group of states and people called Anti-Federalists, such as James Madison, believed the document was missing greater constitutional protection for individual liberties, and so the Bill of Rights was added to safeguard individual liberty and put particular prohibitions on governmental power.

The very first amendment came about after thousands of years of religious control over people's speech and thus their lives. Time and again, history provides examples of how thinking and thus saying something that contradicted governmental power or religious norms was construed as blasphemy, causing the torture or cruel killings of many people, which is not unlike events of late.

Thus, our forefathers gave us the freedom to be religious, Christian or otherwise, or not be religious, believing this would stop such barbaric acts then and in the future--our future. So written by James Madison, the 10 Bill of Rights came into existence, with the First Amendment stating:

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances.

Under these rights, we have built a nation of people who for the most part have respected and even fought for these bills to live on, even if they strongly opposed the thinking of others for whom they fought for. So why now are journalists, cartoonists, bloggers and even little girls being kidnapped, tortured and having their lives brutally ended for showing a picture of their prophet?

In the section of the Koran where Mohamed speaks of killing and of wars against the Christians, promising salvation in the afterlife, it was not meant for innocents. Muslims, Christians and Jews have fought for thousands of years in the Middle East for control over that land of which they perceived had mystical or religious endowments. 

This is not the case in 2015, and it is not just Westerners that hold freedom of religious belief and thought as sacred. In fact, it is only a very few amount of people who have devitalized the words of their prophet and used them to herd others, torture and kill. 

We can't let this continue. Two hundred Christians girls went missing today. Dozens of journalists and aid workers have been kidnapped, with many of those having their heads slowly sliced off while awake. And yet another was beaten and set afire. 

I believe that since World War II, this is the only war we should fight. It is a direct affront to our way of life. And yet Obama keeps saying no boots on the ground; no war. And each day as our government tries to keep us from going to war with these barbaric people, like in WWII, more and more people are forced to live under the direct rule of these morons and more morons are joining their "cause." Well, morons, I hope you enjoy these!