Doctor: Goodbye, fee-for-service

Aftershocks of health care reform may rock doctors’ fee-for-service model from the moorings of the health system. Under scrutiny in the regulation-writing phase, veteran Dr. David Barbe said, is the longtime model where physicians are reimbursed for patient and procedure volumes.

Barbe, who visits with about 25 patients a day between St. John’s clinics in Mountain Grove, Willard and Houston, is embracing a redesign that rewards quality, evidenced by the law’s incentive payments in 2013 to hospitals that meet standards.

“Maybe the doctor’s schedule of the future is a half-day of direct patient care,” he said, mixed with phone and electronic interactions, including text messages, from doctors and allied health professionals, emphasizing patient education. “There are going to be some fundamental changes.”

For instance, a bundled payment model in Medicare revisions in 2014 offers a lump sum for an episode of care versus a la carte treatment and pay.

While Barbe takes the payment debate in stride, he’s leery of the plan’s Medicaid expansion to include coverage to individuals at 133 percent of poverty, or $29,300 for a family of four. He said current reimbursement rates – which are between 7 percent and 26 percent of commercial payers – already discourage doctors from seeing such patients.

“Throw us a bone. Doctors want to take care of patients,” Barbe said. “That’s how I feed my family and pay my rent, but my ulterior motive is to ... help people be healthy. It’s been a national tragedy the way federal payment has taken advantage of a physician’s professionalism.”
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