Payment reform is a major buzz word in Washington DC when it comes to physician fees and payments.  It is also a red flag for many physicians as well.  The main problem again stems from insurers. Why?  First, although doctors have fees schedules within their practices, most if not all receive the majority of their payments ‘under contract’ with health insurers and health plans, which outline the fees that will be paid.  So actual charges filed by a doctor have little bearing on what is finally received.  Second, insurers place so many hurdles on payment, that most physicians run accounts receivable out as much as 60 to 120 days.  That is a long time to wait for payment.  On top of that, payment from insurers is almost always grossly discounted from the internal practice fee schedule.  For example, the Medicare fee schedule, on average, corresponds to payment at the 25-35% of fee for service level for most doctors.  Private carriers, who usually follow Medicare rates over time, have reduced payments to the 40-60% of fee for service range in most cases.  The survey below points to some possible avenues for change, but continued constraint of payments to providers will decrease access and limit availability of high quality care . . . jomaxx

According to the latest Commonwealth Fund/Modern Healthcare Opinion Leaders Survey: 

• 91% believe the current approach to healthcare payment, where payment is given to each provider for individual services provided, is either not effective or somewhat effective at encouraging high-quality care
• The survey included 222 leaders with backgrounds in academia, health policy, healthcare delivery, finance, and business
• 85% were in favor of fundamental payment reform with broader incentives to provide high-quality and efficient care over time as an effective way to change the system
• 62% indicated that a blend of modified fee-for-service and bundled per-patient payment systems would be effective
• 37% believed that pay-for-performance is an effective means to improve efficiency

Read more on this topic @ http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=716275#areaCitation

• K. Stremikis, S. Guterman, and K. Davis, Health Care Opinion Leaders’ Views on Payment System Reform, The Commonwealth Fund, November 2008