Grand Rounds Panel Discussion: Provider Payment Reform: Past, Present, and Future

Panelists: Gregory C. Kane, MD, FACP The Jane and Leonard Korman, Professor and Chairman, Department of Medicine David B. Nash, MD, MBA The Dr Raymond C and Doris N Grandon Professor, and Dean of the Jefferson College of Population Health Rhea E. Powell, MD, MPH Assistant Professor of Medicine Rachel B. Sorokin, MD, FACP Associate Professor of Medicine and Medical Director of Safety and Quality Lawrence D. Ward, MD, MPH Associate Professor of Medicine and Vice Chairman for Clinical Practice and Quality Introduction: The impetus for provider payment reform in healthcare grew out of the recognition that growth in healthcare spending in the United States has been unsustainable and that despite this, the United States has not achieved better health for its population when compared to other developed nations.1 Numerous factors have been identified as potentially contributing to burgeoning healthcare spending, including inadequate primary care and avoidable complications of care.2 Among these factors targeted for reform was the fee-for-service payment structure in healthcare which was thought to incentivize more care rather than better care.3-4 In this context, the Affordable Care Act (ACA) was passed in 2010 not only to expand access to care, but also to redirect Centers for Medicare and Medicaid (CMS) reimbursements for healthcare services and to address the growing demand to curb healthcare spending by rewarding value over volume. Following the ACA, the Medicare Access and CHIP Reauthorization Act (MACRA) was passed in 2015 to repeal the Sustainable Growth Rate formula and to expand the scope of value-based payment structures in healthcare