Where We Stand
Section: Health Care Financing
Policy: Payment Reform

Appendix C

1. Physicians, other health care providers and informed patients must be the core decision makers for each patient’s individual health;
2. The planning and implementation of payment reform models must include broad participation by physician groups and should be conducted in a transparent manner;
3. Physicians must have a leadership role and decision making authority over the distribution of shared savings and bonus payments;
4. Policies should create incentives to prioritize healthy lifestyles and emphasize personal responsibility in addition to improving medical quality and outcomes.
5. All payment reform models must be designed to mitigate the practice of defensive medicine.

1. Payment reform models must recognize and support the essential contributions primary and specialist physicians make to excellent care;
2. Stakeholders should be mindful to determine which diagnoses or treatments may be increasing costs inefficiently based on best practices and address those specifically instead of simply decreasing provider payments or patient benefits.

3. The OMA confirms support of comparative effectiveness research (CER) as a means to guide physicians in the best care options for their patients. It also supports that physician discretion in the treatment of individual patients remains central to the practice of medicine.

1. Any new initiatives should provide adequate timeframes and resources for implementation;
2. Legal restrictions to some payment reform models will need to be examined; necessary legal changes should be pursued, such as changes to antitrust restrictions within cost sharing arrangements;
3. Recognizing that multiple pathways exist to meaningful reform, and that hybrid approaches may help to minimize unintended consequences, demonstration projects that allow for innovation and for physicians to effect change within their local communities should be encouraged;
4. Pilot payment reform projects must be evaluated carefully to determine that they are efficient and effective in delivering high quality care before broader implementation;

1. Discussions of bundled or global payments should reflect a fair representation of all stakeholders in the distribution of payments; no stakeholder should have an advantage over another;
2. New payment models should not be based on Medicare’s fee-for-service payment rates and methods because of inherent flaws with its formulas, such as the Sustainable Growth Rate and geographic payment disparities;
3. Payment reform models must consider smaller and solo practice clinics and should be flexible in design to allow these practices to meet the needs of their communities;
4. Quality measures for payment reform models within different payer systems, such as pay for performance, should be based on specialty-specific,evidence-based standards where applicable; such evidence should also be used to guide clinical decision making;
5. Reform models must adequately compensate providers for team-based care and coordination, including management, consultation with other health care providers and non face-to-face communication with patients.