How May the Transition to Value-Based Payment Influence Gastroenterology: Threat or Opportunity?

Abstract

G has experienced a surge of innovation and growth over the past decade, with major advances in diagnostic and therapeutic endoscopic procedures and in the basic understanding of disease pathology, including genetics and molecular mechanisms. These advances have been facilitated by the entrepreneurial efforts of innovative gastroenterologists, reasonable federal funding levels, investment opportunities with a high profit potential in an era of increasing obesity, an aging population, and a fee-for-service payment model that has favored procedure-based specialties. Change, however, is coming. On the one hand, the threat posed by increasing health care costs is clear: increasing federal deficits as far as the eye can see,1 state budgets in hich increasing Medicaid costs crowd out education,2 and declining take-home pay for the average American owing to increasing insurance premiums and federal borrowing to finance Medicare.3 On the other hand, evidence that much of S health care spending is wasted has shifted the conversaion4 and contributed to the sense of crisis. Whether under epublican proposals (such as the Ryan plan), private health lans’ pay-for-performance5 and global payment initiatives,6 or current federal policy, benefit designs and payment policy are moving inexorably toward approaches that will emphasize value over volume. Accountable Care Organizations (ACOs) represent a major focus of both public policy and private health plan activity.7 These organizations represent collaborations of health care professionals and service providers structured around patient-focused aims (better health, better technical quality, and improved care experience), provider accountability (performance measures), and payment reforms that provide financial incentives for quality improvement and lower costs. Given the emphasis inherent in ACOs on improving care and lowering costs for enrolled populations, some have expressed concern that specialties such as gastroenterology may be threatened by declining investment to support innovation. Although it is unclear what ultimate role ACOs or the shift to value-based payment will have in changing health care