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PEDIATRICS

OUR HEALTH CARE

FINANCING SYSTEM:

We get what we pay for and complain that we

are not getting what we do not pay for.

By Juan Ferreris, MD, MHA, FAAP

ur current and proposed future health care financing quality and satisfaction based on a perception of a practice’s access
O systems create real obstacles to providing patient- and patient centeredness, a PCMH model makes absolute sense as

centered, value-based care for our pediatric patients.
a model to address these two factors. Unfortunately, primary care
Our current financing system is a fee-for-service pediatricians are at the lowest end of the pay scale because payment
model of payment. More procedures and tests and less time spent models of current continue to focus on the procedure and specialty
in direct patient care results in greater payments to providers that focused RBRVS system.
provide high-cost procedures and spend little time face to face Even the payment models in transition still do not provide any
with patients on prevention and wellness. The planned and de- more than a 5-10 percent incentive at the most. With this current
sired move towards a system of financing that rewards improved reality, the progress towards improved access and outcomes in our
outcomes while increasing access and quality cannot logically health care system cannot occur. Hence, while the “language spo-
occur if our payment structures continue to reward procedural ken” by government and private payers rings true with pediatricians,
and specialty care. the actions taken thus far lack the support in the form of increased
Since our primary care pediatricians spend most of their time in compensation for the time-consuming work of direct patient care.
non-procedural activities such as counseling, wellness and disease Until we actually change the way we value direct patient contact
prevention, and coordinating care, the current system of payments time, a change in the metrics of access, quality and therefore im-
based on Medicare RBRVS, which “values” only high-cost time proved overall population health will never be a reality. How can
and procedures, undervalues primary care work. Ironically, the only our current and future financing systems expect primary care pe-
hope of cost controls and improvement in quality and access rests diatricians to spend more time in already undervalued activities such
for a large part on the time spent by the primary care physician as PCMH if pediatricians and their patients are already some of
doing exactly these undervalued activities. As we look towards the the lowest cost centers in medicine? Therefore, we should not be
near future, the Affordable Care Act seeks to encourage the devel- surprised when our current health care financing system continues
opment of patient-centered medical homes (PCMH) as a means to pay for expensive procedure-oriented care while lamenting the
to increase access and quality. However, PCMH implementation fact that we are not getting improved health outcomes and coordi-
and certification is difficult, time consuming and rife with bureau- nation of care simply because we do not pay for it.
cratic processes.
The additional staff resources required to implement PCMH is Dr. Juan Ferreris is the Medical Director of The Chil-
not offset by any increase in proposed payments from insurers. In dren’s Hospital of SA Pediatric Group and is a physician
fact, most compensation plans have at most a 5-10 percent patient educator with Baylor College of Medicine and UT Health as
satisfaction or “quality” component. Given that patients measure clinical adjunct faculty.

22 San Antonio Medicine • June 2018