Wednesday, April 15, 2015

Only 36% of CT physicians have any shared savings arrangements, correcting questionable SIM estimates from 2013 driving expansive policy

UConn’s new SIM survey of CT physicians found that currently only 36% of CT physicians participate in any shared savings or ACO program. There is no information on whether shared savings are a significant part of revenues in even the minority of physicians who are in this payment model. Not surprisingly, shared savings is slightly more prevalent among physician owners of practices. This new number, based on a proper randomized survey, is far below SIM’s questionable assertion in September 2013 that 62% of CT physicians had shared savings contracts, and the number was growing quickly. At the time, advocates and provider groups raised significant concerns about the accuracy and methodology used to generate this number. Unfortunately, that number was used at the time to argue that shared savings was prevalent in our state and there was no danger to including strong SIM policies to compel the payment model across the entire state. This points out the critical need for good, unbiased data to drive policy decision-making in CT reforms.

The survey includes other interesting information. Busting another myth, 73% of physicians working in CT Patient-Centered Medical Homes are from small or medium-sized practices. Thankfully a SIM steering committee member pointed out that while only one in three physicians believe PCMHs improve the quality of care, you would get a very different answer from consumers. There is strong evidence in the literature and here in CT’s Medicaid program of improved quality in PCMHs. Echoing almost exactly CDC’s recent survey, UConn found that 73% of physicians are accepting new Medicaid patients. This is up from 61% in a survey from before Medicaid shifted its financial model away from risk to the current model that emphasizes quality and care coordination.