Physicians' opinions about reforming reimbursement: results of a national survey.
BACKGROUND
Several strategies have been proposed to reform physician reimbursement while improving quality of care. Despite much debate, physicians' opinions regarding reimbursement reform proposals have not been objectively assessed.


METHODS
We conducted a national survey of randomly selected physicians between June 25 and October 31, 2009. Physicians rated their support for several reimbursement reform proposals: rewarding quality with financial incentives, bundling payments for episodes of care, shifting payments from procedures to management and counseling services, increasing pay to generalists, and offsetting increased pay to generalists with a reduction in pay for other specialties. Support for the different reform options was compared with physician practice characteristics.


RESULTS
The response rate was 48.5% (n = 1222). Four of 5 physicians (78.4%) indicated that under Medicare, some procedures are compensated too highly and others are compensated at rates insufficient to cover costs. Incentives were the most frequently supported reform option (49.1%), followed by shifting payments (41.6%) and bundling (17.2%). Shifting payments and bundling were more commonly supported by generalists than by other specialists. There was broad support for increasing pay for generalists (79.8%), but a proposal to offset the increase with a 3% reduction in specialist reimbursement was supported by only 39.1% of physicians.


CONCLUSIONS
Physicians are dissatisfied with Medicare reimbursement and show little consensus for major proposals to reform reimbursement. The successful adoption of payment reform proposals may require a better understanding of physicians' concerns and their willingness to make tradeoffs.
Mount Sinai School of Medicine, New York, NY 10029, USA. alex.federman@mssm.edu
Alex D
AD
Federman
Mark
M
Woodward
Salomeh
S
Keyhani
D001291:Attitude of Health Personnel; D005260:Female; D018166:Health Care Reform; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics* / Q000639:trends; D008875:Middle Aged; D010820:Physicians / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000331:legislation & jurisprudence*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014481:United States