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The American Journal of Managed Care August 2015
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Global Payment Contract Attitudes and Comprehension Among Internal Medicine Physicians
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Global Payment Contract Attitudes and Comprehension Among Internal Medicine Physicians

Joshua Allen-Dicker, MD, MPH; Shoshana J. Herzig, MD, MPH; and Russell Kerbel, MD, MBA
Four years following engagement by an urban care organization in global payment contracts, a majority of internal medicine physicians there were supportive of this action.
ABSTRACT
 
Objectives: Global payment contracts (GPCs) are increasingly common agreements between insurance payers and healthcare providers that incorporate aspects of risk adjustment, capitation, and pay-for-performance. Physicians are often viewed as potential barriers to implementation of organizational change, but little is known about internist opinion on GPC involvement or specific internist attributes that might predict GPC support. We aimed to investigate internist and internal medicine subspecialist support of GPC involvement, and to identify associations among physician attributes, GPC knowledge, and GPC support. 

Study Design: Cross-sectional.

Methods: General medicine and internal medicine subspecialist physicians within the Beth Israel Deaconess Department of Medicine in Boston, Massachusetts, were surveyed 4 years after care organization entry into a GPC. Measurements collected included reported support for GPC involvement, reason for support, and demonstrated comprehension of key GPC details.

Results: Of the 281 respondents (49% response rate), 85% reported supporting involvement in a GPC. In a multivariate ordinal logistic regression model, exposure to prior information about GPCs, demonstrated comprehension of key GPC details, longer time since completion of residency, and lower clinical time commitment were all independently associated with higher levels of GPC involvement support. 

Conclusions: Four years since first engaging in a global payment contract, a majority of internal medicine physician respondents support this decision. Understanding predictors of physician support for GPC involvement within our care organization may help other health systems to approach organizational change. Health system leaders debating GPC involvement should consider engaging physicians via educational interventions geared toward improving GPC support.

Am J Manag Care. 2015;21(8):e474-e479
Take-Away Points
 
While physicians may be frequently viewed as potential obstacles to organizational change in healthcare, 4 years after an urban care organization engaged in payment system redesign, a majority of internal medicine physician survey respondents were supportive of this decision.
  • Physician attributes independently associated with support included greater demonstrated knowledge, prior exposure to informational sources, lower clinical time commitment, and time since residency completion. 
  • Physician education efforts, whether formal or informal, may be effective tools for shaping physician opinion on an organizational level.
Recent health reform efforts center on developing market incentives to promote high-value care.1-4 In this environment, global payment contracts (GPCs) are increasingly common. GPCs rely on the sharing of responsibility for cost and quality of care between insurance payers and healthcare providers.5,6 This approach incorporates aspects of risk adjustment, capitation, and pay-for-performance.
 
Physicians have been identified as being a potential obstacle to successful implementation of such recent payment reforms.7-9 Proposed reasons for this challenge include perceived threat to physician autonomy, uncertain financial benefit, physician averseness to risk, and residual antagonism following the managed care organization disputes of the 1990s.5,10,11 We were not able to locate any publications on the role physicians are playing in the organizational change required for GPC adoption.
 
Through a survey of general medicine and internal medicine subspecialist physicians in a care organization engaged in multiple GPCs, we aimed to quantify internist support for GPCs, quantify internist comprehension of key information relevant to GPCs, and identify specific physician attributes that might predict GPC support.
 


 
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