International Journal of Advance Innovations, Thoughts & Ideas
Open Access

The United States has some of the highest healthcare spending per person in the world. Costs have been rapidly increasing, with health care spending reaching $3.8 trillion ($11,582 per person) in 2019 and accounting for 17.7 percent of total gross domestic product (GDP) .The United States has failed to provide the finest quality of healthcare in the world despite its high health care spending. The United States ranks worst in terms of access to care, administrative efficiency, equity, and health care outcomes, according to a research comparing the performance of health care systems in 11 high-income nations Although the United States possesses some of the most cuttingedge research, technology, and facilities in the world, our health care outcomes have been ineffective.

One of the main causes of the nation's expensive health care expenses is thought to be the fee-for-service pay system The National Commission on Physician Payment Reform was established in March 2012 by the Society of General Internal Medicine to investigate the variables affecting such expenditures throughout the healthcare system. They identified a number of significant causes, but fee-for-service reimbursement was one that stood out There is general agreement that fee-for-service compensation does not do enough to promote the delivery of effective, high-value treatment, giving doctors little incentive to refuse services even when they are exorbitantly expensive and have uncertain benefits Instead, the current system encourages a rise in service volume, discourages care coordination, and encourages ineffective delivery.

To lower total health care costs while improving care, moving physician compensation away from the fee-for-service model and toward an alternative in which cost-savings and quality of care are considered as standards is promised. In other words, focusing on the doctor directly reduces costs by curtailing unnecessary (i.e. ineffective) care. Numerous institutions, including the U.S. government, have focused on this transition in light of Congress' passage of the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015, which aims to base Medicare reimbursement on results and value. This legislation,along with other other programmes such as at-risk managed care contracts), aims to meet the triple purpose of healthcare increasing patient experience, improving population health, and reducing per capita costs but hasn't yet shown that it produces lasting.

Subjective Heading

The objectives of the organisation should be supported by the new remuneration scheme. In any small medical organisation with only a few endocrinologists, a fee-for-service model with compensation determined solely by income is probably the most alluring choice for both the individual doctors and the whole group. However, it is not the greatest long-term solution for our extensive health system, which is about to implement value-based contracting. Since our system is connected with a sizable insurer, the Enterprise's short- and long-term objectives must focus on enhancing care and reducing costs. In order to achieve this purpose, the compensation plan should be created by eschewing fee-for-service remuneration.

Discussion

To maintain patient access to providers and to allay any worries that providers may have about this organisational change, the transition from fee-for-service payment to a new model should be gradual, with fee-for-service continuing to be an important component of physician payment during the transition period.Because there aren't enough endocrinologists in the nation, the new compensation scheme ought to help reduce referrals to endocrinologists.

An endocrinologist would get a conditional incentive payment under the terms of our suggested contract in exchange for their efforts as determined by specified performance criteria. While the plan implements a revolutionary value-based payment structure, it also brings about another practical change in workflow by assisting primary care doctors in managing diabetes and other endocrinerelated diseases from a population-based perspective. As was already indicated, switching to a new model should be gradual, with fee-forservice payments to doctors continuing to be essential during this time. As a result, our team started putting this change into practise by establishing two distinct tracks of compensation: transformative and clinical.

Participants in this programme divided their time between clinical and non-clinical responsibilities 60/40. Endocrinologists are only required to do clinical tasks (in-person patient interactions) three days a week, freeing them the other two days for their other commitments. A shared care approach unites each participating endocrinologist with a number of primary care offices in a specified area. The following objectives guide the endocrinologist's twice-yearly visits to each of the designated practices ensuring that these practises have the resources necessary to manage diabetic patients, engaging in evidencebased conversation with PCPs, and offering ongoing assistance with technologies like an e-Consult and standardised treatment algorithms. This strategy will enable a positive and long-lasting interaction between PCPs and the endocrinologist they have been allocated. Base salary, a productivity bonus, and compensation for non-clinical responsibilities make up the overall compensation for the revolutionary track.

Ensuring that these practises have the resources necessary to manage diabetic patients, engaging in evidence-based conversation with PCPs, and offering ongoing assistance with technologies like an e-Consult and standardised treatment algorithms. This strategy will enable a positive and long-lasting interaction between PCPs and the endocrinologist they have been allocated. Base salary, a productivity bonus, and compensation for non-clinical responsibilities make up the overall compensation for the revolutionary track.

Fee-for-service remuneration is still a crucial component of this approach since it lessens the impact on provider access and allays any worries that providers may have about the change. The clinical track provides a substitute for endocrinologists who may be reluctant to assume the non-traditional role that the transformative track needs, even if the objective is to have all doctors on this track. Base salary, productivity bonuses, and a quality bonus make up total remuneration.

Goals for productivity and base pay (88.5% of total compensation): The MGMA survey findings were used to calculate base wage, with total compensation equal to the 50th percentile of salaries reported in the survey the previous year. Relative-value units (RVU) equal to the survey's 50th percentile RVU count were used to calculate the productivity target.

If the doctor meets preset quality metrics, patient satisfaction survey targets, and abides by the network and division policies and procedures, they will receive a quality bonus (11.5 percent of total remuneration) at the conclusion of the calendar year.

Productivity bonus: If physicians exceed the RVU threshold established for base salary, they may be eligible to receive additional compensation.

In July 2019, the new pay model went into effect with the intention of tracking how it affected the performance and satisfaction of endocrinologists and PCPs. Unfortunately, the COVID-19 epidemic forced us to make a number of changes to our regular office procedures, including moving most patient visits to two-way video sessions and modifying outcome measures (such in-person foot checks) and elective tests. Additionally, many of the additional activities that our endocrinologists were expected to perform in the framework of this compensation plan have been influenced by the pandemic and the changes that it brought with it.

For instance, it was essential to move to video visits for the following 18 months after the initial 6-month in-person appointments with participating PCPs. Despite these unanticipated adjustments, in the first nine months of the compensation model (before the pandemic began), we saw the new model's initial effects on the way we deliver treatment and a change in the dynamic between participating specialists and PCPs.

The number of referrals for diabetes education to our Certified Diabetes Care and Education Specialist (CDCES) has increased, with more than 65 percent of these referrals resulting in an appointment, as a result of our endocrinologists' promotion of diabetes education as one of the most efficient, crucial, and underutilized tools in diabetes management .Ultimately, one of the key objectives of this new compensation scheme is to raise PCP quality standards and the standard of diabetic care. Each quarter, data were retrieved from the Electronic Health Records system and compared to practice- and provider-level quality metric data adopted from the HEDIS standards of diabetes care. This early evidence indicates an improvement in quality measures specific to diabetes .At the conclusion of the first year of our compensation pilot, 16 of the 54 target practises received diabetes management recognition from the National Committee for Quality Assurance (NCQA). practises replied to a survey distributed during patient visits, and 88 percent of these practises' physicians reported a satisfaction score of > 90 percent.The responders emphasized the value and importance of meeting with their partnering endocrinologists and concluded that the information gleaned from these sessions would be implemented in their clinics. In addition, our participating endocrinologists noted that they felt greater personal and professional satisfaction in this model than the previous fee-for-service model.

Conclusion

In the first year, each endocrinologist was given responsibility for managing about 14 Primary Care Practices. Our endocrinologists were able to meet with 92.6 percent of the assigned PCPs because to our outreach efforts to all 54 of the practices in the area, which resulted in a total of 50 visits over the first six months. Traditional referrals to endocrinology decreased throughout this time, whereas the use of e-Consults increased by 418 percent with an average of 20 per month. Over the following 18 months, our endocrinologists were able to keep the average turnaround time for e-Consults at 8.85 hours.

Acknowledgement

I would like to thank my Professor for his support and encouragement.

Conflict of Interest

The authors declare that they are no conflict of interest.