How Otolaryngologists Are Adjusting to Value-Based Compensation Amid Mixed Success in Primary Care Settings

on specialty care remains high despite the efforts of PCP-focused models,” Merta added.

According to Dr. Naunheim, inertia is a “huge problem” when implementing VBC models. “Fee-for-service is the status quo, and it will be hard to change,” he said, due to the risk of financial disadvantage associated with a value-based model. “Additionally, there will be a new administrative burden—an outcome that many physicians, already burdened by the burgeoning cost and oversight of hospital administrators, fear immensely. The cost of this administrative burden is likely to be high,” Dr. Naunheim added.

“We need resources from our specialty groups, created by physicians,” said Dr. Naunheim, adding that the CMS recommendations are unlikely to help most otolaryngologists. “There has already arisen a cottage industry of third-party consultant ‘experts’ who will be happy to take your money in exchange for a slick PowerPoint presentation and then sail off into the sunset. Caveat emptor,” he said.

Future Support

Merta, who is actively engaging those involved with otolaryngology, orthopedics, cardiology, ophthalmology, and other specialties, noted that the challenges associated with implementing VBC models for physicians include resisting change from traditional fee-for-service models; handling data collection and analytics requirements; ensuring fairness and transparency to compensation; and balancing quality of care with financial incentives.

“Overall, transitioning to VBC models requires careful planning, stakeholder engagement, and ongoing evaluations to ensure alignment with the goals of improving patient care while controlling costs,” Merta said. “A great deal of resources and expertise has been directed at PCPs. While effective in some scenarios, the cost of specialty care remains a challenge, which explains the focus of CMS and other payers.”

To support physicians in navigating VBC models, Merta suggested that healthcare organizations provide:

• Training on quality improvement and value-based care principles;

• Access to data analytics and performance-tracking tools;

• Assurance that a practice is optimized for efficiency and patient engagement;

• Understanding of the contract structures with payers or the at-risk entity;

• Collaborative approaches involving physicians in decision-making processes; and

• Financial incentives tied to achieving quality and outcome targets.  

Katie Robinson is a freelance medical writer based in New York.