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Government Relations Symposium Addresses the Pressing Question: Is This the End of Fee-for-Service?

New Format Featured Individual Remarks by Harold Miller and Steve Forbes, as well as Thought-Provoking Panel Discussion

On Sunday afternoon, during the 2019 ASCRS ASOA Annual Meeting in San Diego, attendees of the Government Relations Symposium were treated to a new and different program format that offered interesting answers to the question (and symposium title), Is This the End of Fee-for-Service? The issue is an important one for ophthalmology, as there is a bipartisan effort to move physicians out of fee-for-service and into alternative payment models (APMs), none of which are currently a good fit for our specialty. The push toward value-based care is high on the Trump Administration’s agenda, with Health and Human Services (HHS) Secretary Alex Azar and Center for Medicare & Medicaid Innovation (CMMI) Director Adam Boehler both recently speaking out against the fee-for-service system. Mr. Boehler called it “antiquated” and said one of his “prime goals” is to “blow up fee-for-service.”

ASCRS Government Relations Committee Chair Parag Parekh, MD, MPA, kicked off the session with a brief presentation on the importance of members participating in the society’s advocacy efforts and supporting eyePAC. He then went on to introduce the first speaker, Harold D. Miller, a nationally recognized expert on healthcare payment and delivery reform, and a panel of ASCRS and ASOA members representing a variety of practice sizes and geographic areas. In addition to Dr. Parekh, panelists included Tal Raviv, MD, FACS, founder and medical director of the Eye Center of New York, clinical associate professor of Ophthalmology at New York Eye and Ear Infirmary of Mount Sinai, and a member of the ASCRS Cataract Clinical Committee; fellow ASCRS Cataract Clinical Committee member Neal Shorstein, MD, associate chief of quality for Kaiser Permanente’s Diablo Service Area in California, who also is actively involved in Kaiser Permanente research; and Joe Theine, MBA, COE, practice administrator at Four Corners Eye in Durango, Colorado, and vice president of ASOA.

Mr. Miller, who is president and CEO of the Center for Healthcare Quality and Payment Reform, gave an enlightening presentation about designing value-based healthcare from the bottom up rather than the current “top-down” approach, discussed what is wrong with the current fee-for-service payment system, as well as problems with shared savings and population-based payments, and offered a possible solution: APMs designed by the people who know how care is delivered in the real world on a daily basis—physicians. He offered four steps for creating a good APM from the physician perspective, which would also prevent patients from getting the “short end of the stick.” These steps include (1) identifying opportunities to reduce avoidable spending, (2) identifying barriers in current payments that need to be fixed, (3) designing payments that remove current barriers, and (4) including accountability for spending that is within the physician’s control. Mr. Miller also has made his presentation available on his organization’s website. Whether or not you attended the symposium, you can access his slides here.

Following his own presentation, Mr. Miller moderated a brief panel discussion by Dr. Parekh and the ophthalmologists  and practice administrator listed above, all of whom participate in different healthcare delivery models and were able to offer insight into their own experiences. During the discussion, the audience participated by both asking questions and participating in an audience survey.

For the final segment of the symposium, Dr. Parekh introduced the keynote speaker, Steve Forbes, chairman and editor-in-chief of Forbes Media and two-time presidential candidate, whose Forbes Healthcare Summit gathers world-class CEOs and industry experts to unveil the latest breakthroughs in science, address controversial issues head-on, and turn the healthcare system’s challenges into new opportunities. In his talk, Mr. Forbes was adamant that fee-for-service is not dead and offered his perspective on the impact of healthcare on the economy, noting that we have excellent care in this country, but that it is mostly still third party. This, he said, causes a disconnect between doctors and patients that you don’t see in other industries. He agreed with Mr. Miller that a bottom-up approach is what is needed, rather than the current top-down proposals that are trying unsuccessfully to “do what would naturally happen in a free market.” He said that the future will bring continued debate on what type of payment system is the right one but said optimistically that he thinks it will be a free market system in which doctors and patients are once again what matters.

The Government Relations Symposium soon will be available for online viewing exclusively to ASCRS and ASOA members who attended the Annual Meeting.

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