For example, the recommendations could have effects on other Medicare payment systems, a dynamic that will need to be considered more fully. Within this context, and because the committee has recommended an integrated approach in which the payment system for hospitals and practitioners is based on common data sources and similar payment areas, the committee urges a systematic and phased-in process of moving forward to ensure that providers, regulatory agencies, and others take a coordinated and transparent approach toward implementation.

As the committee looks to the future, it is important to note that the current fee-for-service system that has been dominant in American health care for decades is now changing. New payment incentives introduced by CMS are intended to reward value over volume, meaning that providers will be rewarded for providing higher-quality, more efficient care and penalized for preventable errors such as hospital-acquired infections. The practice choices of new physicians are also changing, with an increasing number now accepting salaried positions with hospitals and health systems after completion of their residency training. More established physicians are also selling their practices and accepting salaried positions (Harris, 2010). According to a 2010 survey of physicians’ starting salary, nearly half of the nation’s new physicians are salaried (MGMA, 2010).

The health care workforce is undergoing other significant changes. The introduction of electronic health records and health information technology (HIT) is requiring a different kind of training and workflow in clinical practice. Another major development in the workforce is related to scope of practice for advanced practice nurses, physician assistants, and other licensed health professionals. For example, a recent Institute of Medicine (IOM) report endorsed the effort of nurses to expand their scope of practice and recommended that nurses be licensed to practice up to the full skill level of their training (IOM, 2010).

In addition to marking these larger trends in medical and nursing education and care delivery, the phase 2 report also marks a transition for this committee from focusing on and data sources to improve accuracy of payment to achieving policy objectives related to the statement of task. The committee members look forward to the opportunity to address the policy goals of helping to create an equitable payment system that rewards high-value and high-quality health care.


Harris, G. 2010. More doctors giving up practices. New York Times. March 26, 2010. (accessed March 25, 2011).

IOM (Institute of Medicine). 2010. The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.

MGMA (Medical Group Management Association). 2010. MGMA physician placement report: 65 percent of established physicians placed in hospital-owned practices. Engelwood, CO: Medical Group Management Association. (accessed March 8, 2011).

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