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The American Journal of Accountable Care June 2018
Amazing Grace: A Free Clinic's Transformation to the Patient-Centered Medical Home Model
Jason Alexander, BS, PCMH CCE; Jordon Schagrin, MHCI, PCMH CCE; Scott Langdon, BA; Meghan Hufstader Gabriel, PhD; Kendall Cortelyou-Ward, PhD; Kourtney Nieves, PhD; Lauren Thawley, MSHSA; and Vincent Pereira, MHA, PCMH CCE
Lessons Learned in Implementing Behavioral Screening and Intervention
Richard L. Brown, MD, MPH
The Intersection of Health and Social Services: How to Leverage Community Partnerships to Deliver Whole-Person Care
Taylor Justice, MBA, President of Unite Us
Case Study: Encouraging Patients to Schedule Annual Physicals
Nicholas Ma
Effects of an Integrated Medication Therapy Management Program in a Pioneer ACO
William R. Doucette, PhD; Yiran Zhang, PhD, BSPharm; Jane F. Pendergast, PhD; and John Witt, BS
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Are Medical Offices Ready for Value-Based Reimbursement? Staff Perceptions of a Workplace Climate for Value and Efficiency
Rodney K. McCurdy, PhD, and William E. Encinosa, PhD
Cost-Effectiveness of Pharmacist Postdischarge Follow-Up to Prevent Medication-Related Admissions
Brennan Spiegel, MD, MSHS; Rita Shane, PharmD; Katherine Palmer, PharmD; and Duong Donna Luong, PharmD

Are Medical Offices Ready for Value-Based Reimbursement? Staff Perceptions of a Workplace Climate for Value and Efficiency

Rodney K. McCurdy, PhD, and William E. Encinosa, PhD
This study surveyed 840 clinical and nonclinical staff in 96 medical offices regarding workplace policies and procedures that facilitate a climate for value. 

Objectives: As value-based reimbursement prepares to enter the outpatient setting, little is known about medical offices’ preparedness to face this challenge. Although workplace climate is a strong predictor of organizational performance and patient outcomes, there is a critical lack of evidence regarding a climate for value in frontline medical offices. Our goal was to assess medical office staff member perceptions of a workplace climate for value.

Study Design: The Medical Office Value and Efficiency Survey, developed by the Agency for Healthcare Research and Quality, was pilot-tested among 2315 workers in 96 medical offices. Of these, 840 completed surveys, 57% of whom were clinical staff members. Most respondents worked full time (86%), had been at their current place of employment for at least 1 year (83%), and worked in larger practices with 11 or more clinical staff (70%).

Methods: Percentage of positive survey responses was used for comparisons by occupational role and organizational context.

Results: Medical office staff positively responded to 44.6% of the 25 climate survey statements. Clinical staff were more positive, but few had used data to assess the results of performance improvement activities (8.8%), shadowed patients to improve their care experience (12.4%), or served on a committee to make a work process more efficient (15.7%). Among nonclinical staff, those working in smaller medical offices had more positive perceptions than those in larger offices.

Conclusions: Findings highlight the need for management strategies that emphasize staff training and engagement and the use of performance data and that stress value principles across all organizational activities, including workforce development, performance management, and recruitment.

The American Journal of Accountable Care. 2018;6(2):11-19
With the ongoing implementation of the Medicare Access and CHIP Reauthorization Act of 2015, new physician reimbursement methods continue the trend in payment reform policies attempting to shift the emphasis from volume to value. While the efficacy of such policies is currently being evaluated under many pilot studies,1 researchers have identified the need to better understand the intrinsic motivators contributing to organizational behavior change.2 Organizational climate is the meaning that employees attach to the policies, practices, and procedures they experience in the workplace.3 In healthcare organizations, climate has been empirically associated with staff and patient outcomes.4-9 Workplace climates characterized by high levels of positivity, staff involvement in decision making, and interprofessional collaboration create an appropriate context for the delivery of compassionate, coordinated, and patient-centered services to meet the needs of complex patients.10 Conversely, negative climates have been attributed to poor patient safety outcomes and failed implementation of new interventions and technologies.11,12 Yet, as medical offices prepare for value-based reimbursement, there is a critical lack of evidence regarding staff perceptions of office policies and procedures that facilitate a climate for value in the workplace.

To address this gap, the Agency for Healthcare Research and Quality (AHRQ) sponsored the development and pilot-testing of the Medical Office Value and Efficiency Survey (MOVES). Modeled after the agency’s influential patient safety culture program, MOVES was developed to assist managers in assessing the extent to which medical offices emphasize and adopt processes to promote efficiency, waste reduction, patient-centeredness, care quality, and cost reduction.13 Because value-based reimbursement introduces greater financial risk to frontline medical offices, it is essential to assess their readiness to perform in this new environment. Soliciting staff perceptions regarding internal processes and policies has proved fruitful in understanding complex organizational issues, such as patient safety, in hospitals.14 Similarly, insights from staff with considerable exposure to everyday workplace policies and care delivery practices in frontline providers may offer a unique and highly relevant contribution to this topic.


Although little is known about the current climate for value-based care in medical offices, it will be the centerpiece of outpatient reimbursement by 2019 when Medicare’s Merit-based Incentive Payment System and alternative payment models (eg, accountable care organizations [ACOs]) will be implemented together as the world’s largest pay-for-performance program. Similar efforts are underway in the private sector. The Health Care Transformation Task Force, a new coalition of private insurers and provider organizations, is aiming to move 75% of its contracts into value-based payment models by 2020. As of 2016, about 41% of their contracts were value-based, up from 30% in 2014.15 By putting providers at financial risk to implement value-based care, there is hope that the United States can begin to reduce the annual $750 billion (30%) in excess costs spent on low-value care and overuse.16 At the same time, there is strong interest in keeping small physician-owned medical offices on the front line of value-based care, as recent research shows that they have lower costs and fewer ambulatory care–sensitive admissions.17,18 Similarly, the smaller ACOs were found to have performed better in the 2015 Medicare Shared Savings Program.19

To keep medical offices on the leading edge of value-based care, there is a need to assess their climate for dealing with value-based performance, efficiency, and waste and overuse concepts. Little is known about clinicians’ perceptions of value-based care. The evidence regarding patient perceptions is growing, albeit mixed. A recent AHRQ survey of marketplace consumers found little trust in value-based healthcare, viewing it as an unnecessary external intrusion into their patient–physician relationship.20 Another study, using the AHRQ Consumer Assessment of Healthcare Providers and Systems (CAHPS), found that efforts to improve efficiency and reduce waste in primary care clinics, such as with Lean programs, improved patient satisfaction with access to care but lowered satisfaction concerning interactions with clinicians.21

Whether clinicians have perceptions similar to those of patients in these value and efficiency domains is an open question. Recent provider climate surveys have been limited. Since 2004, AHRQ has maintained a family of 5 surveys to assess the climate and culture of organizations with respect to patient safety, collectively called the Surveys on Patient Safety Culture (SOPS).22 However, the SOPS have not emphasized climates of value and efficiency. To address this weakness, MOVES was designed by AHRQ to specifically fit into its current suite of surveys: the 5 SOPS and the 10 CAHPS surveys.23 In this study, we present the first results from a pilot test of MOVES among 840 staff members in 96 medical offices.

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