MedPAC Focus Groups Provide Snapshot of Clinician Attitudes

In focus groups conducted earlier this year by the Medicare Payment Advisory Commission (MedPAC), some of the clinicians participating in accountable care organizations said they saw few benefits for their patients and minimal financial rewards.

During its Oct. 10 public meeting, MedPAC provided some highlights of focus groups with Medicare beneficiaries and a limited number of clinicians that regularly see Medicare patients in an outpatient setting, including separate groups of primary care physicians, specialists, and nurse practitioners and physician assistants.

Ledia Tabor, M.P.H., Principal Policy Analyst, and Katelyn Smalley, Ph.D., Senior Policy Analyst, at MedPAC, summarized the responses. Tabor noted that due to the nature of focus group research, their sample size was limited, “so findings cannot be generalized to the communities we studied or to the nation as a whole.”

Clinicians' direct experiences with ACOs were limited. Almost all clinicians were familiar with ACOs, but fewer than half were participating. Participating clinicians noted that ACOs have changed the way they work through additional monitoring and rules.

Regarding quality reporting, many of the clinicians felt that quality measures did little to improve patient care and led to unnecessary work. Some noted that quality measures and the reimbursement they receive often do not reflect their patients' complexity.

One specialist commented, "We find that a lot of these metrics don't really adequately adjust for the complexity of the medical situation . . . those metrics for us are tied into a reimbursement, so we follow them. But it's very complex data to analyze and very hard to adjust to get for some of the complexities that some of these patients come with.”

Many clinicians found prior authorization processes to be burdensome. Some clinicians described the need to have dedicated administrative staff to manage paperwork associated with prior authorizations. 

Clinicians also reported that they or staff in their practices spent a large amount of time on prior authorizations for prescriptions. A majority of clinician reported they were using electronic prior authorizations for prescriptions, which was seen as simplifying the initiation of prior authorization and potentially shortening the approval timeline. Some clinicians reported having access to formularies in their EHRs, but reported that the information is often incomplete or inaccurate.

Physicians in physician-owned practices expressed negative feelings about the prospective of being acquired. Some believed that private equity firms were decreasing quality of care, under the belief that they are driven by profits and not patient care. Physicians also commented on the management structure of larger organizations, noting a tradeoff with reduced decision-making power when employed at larger organizations.

Most clinicians mentioned receiving communications from Medicare Advantage (MA) plans, but feelings were mixed about their utility. Some felt the guidance was generic and did not provide useful additional information. Others appreciated when plans flagged enrollees at high-risk of hospitalization or coordinated care across providers for enrollees with complex health needs. Some clinicians noted that information on their patients' medication adherence was also helpful feedback from plans. 

Several clinicians reported that some of their patients had received home visits from their MA plans, but they did not perceive these to be integrated into the care they are providing.

There was a perception among some clinicians that MA plans prioritize coding to get higher reimbursement for their patients. A few clinicians expressed frustration that MA plans sometimes designate them as a patient’s primary care provider, even if they have never seen that patient, in some cases affecting their quality scores.

A few participants were employed by provider organizations that terminated a contract with at least one MA plan. While they were not involved directly in the decision, they reported that contract terminations were difficult for their patients.