Readers of Kaiser Health News, Politico and The Hill ( here , here and here , respectively) were treated to the faux news of another expert report on the tedious topic of physician payment reform. While the Disease Management Care Blog is a big fan of the brainy Society of General Internal Medicine (SGIM), this physician compensation communique is another rehash of "misaligned incentives" leading to "quantity over quality."
The good news is that there may be insights that were missed by KHS, Politico and The Hill. In this instance, the DMCB has been listening closely and found one thing the experts aren't saying.
So why is capitation coming back? The DMCB suspects one reason is that there are only passing references to it and that it's been rebranded with more benign sounding names like "gain-sharing" and "global payments." Another is Medicare FFS fatigue, caused not only by the SGR but by CMS' unending hassles , the uncertainty surrounding PQRS and the dread of having to go through one of those repugnant " RAC audits ." Unwilling (so far) to simply drop out of Medicare altogether, docs are backing into acquiescing to the recommendations of groups like the SGIM.
And why does the DMCB call it Capitation 2.0? Writing in SGIM's Journal of General Internal Medicine more than a decade ago, Thomas Bodenheimer predicted the survival of managed care thanks to the allocation of full capitation to institutions, not individuals. It's then up to those institutions to leverage both FFS and capitation at the individual physician level. The DMCB would add that a third ingredient is tying any payments under capitation to specific quality goals, like control of chronic illness or maintaining access to care.
The DMCB's conclusions?
What they didn't say: The track record of original capitation or advent of Capitation 2.0 doesn't mean physicians are embracing what their organizations and political allies are saying what's best for them. They simply don't see an alternative. The 1990s could happen again.
What they got right, sort of: Outside of large organizations that take capitation, we have much to learn about the best combination of FFS and fixed payments when it comes to physician incentives and protecting patients. Like other reports before it, the National Commission suggests we need 5 years to assess new payment models. Given the decades of experience with managed care's capitation and Medicare's institutional inertia, that may be overly optimistic.