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ASCRS SYMPOSIA ASCRS ASOA ANNUAL MEETING by Ellen Stodola EyeWorld Senior Staff Writer/ Meetings Editor 3. Design payments that remove current barriers. 4. Include accountability for spending the physician can control. To conclude the session, Mr. Forbes addressed the fee-for-ser- vice question. Is this the end of fee-for-ser- vice? Mr. Forbes said, emphatical- ly, no. The impact of healthcare on the economy also gets to the ques- tion of why we have a healthcare crisis in this country, he said. It's not overall quality, he said, because the healthcare in this country is superb. One problem is that we "don't have real free markets in healthcare." It's mostly still third party. This causes a disconnect between providers and consumers that you don't find elsewhere, Mr. Forbes said, so you don't have the normal "fruits" of a free market system. 1. There is no fee for many high-value services that could help patients and reduce overall healthcare spending. 2. Fees don't match the cost of delivering high-quality care. 3. It's impossible for patients or payers to know how much they will have to spend for treatment of a health problem. 4. There is no assurance that a patient will receive high-quality care. Mr. Miller also discussed some of the problems with shared savings and population-based payments: 1. Physicians can receive financial bonuses for denying patients needed services. 2. Payments may not be adequate for patients who need multiple services or expensive services. 3. Physicians are penalized for increases in spending they can't control, such as services ordered by other providers and increas- es in prices by pharmaceutical companies. 4. Physicians don't know how much they will be paid until long after services are delivered. However, Mr. Miller thinks the suggested solution, a value- based payment system through al- ternative payment models (APMs), is being designed the wrong way today (top down instead of bottom up). Currently, CMS defines the plan, and physicians change their care to align with the plan. In this design, the patients "get the short end of the stick," he said. However, if these were designed from the bottom up, the physicians, or people who actually know how care is delivered, would design the plans, with CME imple- mentation. This way, patients get good care, he said. How do you design a good APM? Mr. Miller offered four steps: 1. Identify opportunities to reduce avoidable spending. 2. Identify barriers in current pay- ments that need to be fixed. T his year's Government Relations symposium, titled "Is This the End of Fee-for-Service?" took place on Sunday afternoon. The session featured Steve Forbes, MA, and Harold Miller, MS. Parag Parekh, MD, chair of the ASCRS Government Relations Committee, State College, Penn- sylvania, kicked off the session by saying that it has become fashion- able in Washington, D.C. to blame fee-for-service for everything that's wrong. However, Dr. Parekh said that he testified in Congress about the importance of main- taining fee-for-service and stressed that it was a fundamental build- ing block to the care provided to patients. Mr. Miller presented on designing value-based care from the bottom up instead of the top down. "The big challenge we're facing in the country is how to control healthcare spending," he said. Historically, there have been three traditional methods payers use: cut fees for providers, have the patients pay more, or delay or deny care to patients. The results of these typical strategies, Mr. Miller said, are patients don't get the care they need and costs increase in the future, small phy- sician practices and hospitals are forced out of business, and health insurance premiums continue to rise and access to insurance cover- age decreases. The latest answer to this is to blame the fee-for-service system, he said, and the suggested solution has been to replace it with value- based payment. What exactly is wrong with fee-for-service? He said the four real problems with the current fee-for-service payment systems are: Government Relations symposium tackles fee-for-service "When the system doesn't work, you get all of these top down proposals to do what would naturally happen in a free market," he said. "So, you end up with a distorted system that gets more and more out of control." Mr. Forbes said that it's clear that the top down approach is not going to work. So why not allow for a bottom up approach? He said he doesn't think the U.S. will progress to a socialized medicine plan, but he does think there will be a big debate in the future on what type of system we want to have. We're heading toward more of a free market system where doctors and patients will matter again, he said. Editors' note: The speakers have no relevant financial interests. Mr. Forbes (top) and Mr. Miller speak at the Government Relations symposium on the topic of fee-for-service. 46 | EYEWORLD DAILY NEWS | MAY 6, 2019

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