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Potential Contributions by the Institute of Medicine
The conference participants suggested several potential Institute
contributions to a broad reconsideration of physician payment methods.
There was a high regard for the success of this conference in convening
on neutral gound a diverse group of interested parties, researchers,
policy analysts, and policymakers from the public and private sectors
to consider these controversial issues. A continuing series of such
conferences, each focused on a specific aspect of physician payment,
was seen as a potentially useful contribution to the policy debate. A
related suggestion was that the Institute serve as a clearinghouse for
informal ion on local innovations in physician payment practices,
monitoring the innovations and disseminating information to interested
parties. Such a function might be extended to recommending designs for
systematic evaluations and monitoring ongoing evaluation studies.
Participants also made suggestions for a greater degree of active
IOM involvement in defining directions for reform of physician
payments. Conference participants suggested that an Institute
committee could contribute in the near term by analyzing and commenting
on policies currently under active consideration such as freezing
physician fees, establishing fee schedules, and adopting prospective
payments for inpatient physician services. Such a study would be
directed to measures aimed at immediate cost containment. A
longer-term major study could have an enlarged scope of concern
extending to the effects of physician payments on desired health care
objectives. These objectives, which the study would define
specifically, could include access to primary care, and to preventive
and psychosocial services; use of health resources and technologies;
and distribution of health manpower. With such objectives as criteria,
the study could examine payment options, including all the appropriate
alternatives to fee-for-service payment.
Finally, a number of conference participants urged that the
Institute undertake a study of the relative values of physician
services. Such a study would address directly the issue most cited as
a concern by IOM members: distortions in health care delivery due to
disparities in payment levels for different services. It was felt that
the IOM was an appropriate body to examine the relationship between
existing fee structures across medical specialties and (1) the costs of
providing a service, (2) its medical efficacy, (3) consumer
preferences, and (4) other criteria that might be developed for
establishing ~value,. and to recommend one or more new methods for
developing and updating physician fees. A number of participants
pointed out that the issue of relative value pervades all payment
mechanisms. Efforts to develop a better rationale for valuation would
therefore be helpful in determining payment levels irrespective of
payment methods that might be adopted in the future.
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Representative terms from entire chapter:
physician payment
