A brewing physician-health system disconnect

https://mailchi.mp/7d224399ddcb/the-weekly-gist-july-3-2020?e=d1e747d2d8

Addressing The Consumer-First Disconnect - B&T

We’re hearing from medical groups around the country that in the past few weeks, office visit volumes have quickly approached pre-COVID levels. Some are even busier, running at 110 percent of their February volumes, or more. At the same time, practice has become more stressful, with doctors balancing virtual care with in-person visits, new safety procedures slowing operations, and staff and patients worried about COVID exposure. Everything feels different, and irrespective of the number of patients on today’s schedule, all of the changes make a physician feel like she’s working harder than before.

A chief clinical officer from a Midwestern health system relayed the discord this has created when discussing incentives: “Our doctors were fully on board with the need to reduce salaries back in April, so we all took a 15 percent pay cut through the summer. Now that they’re busy again, they want to be bumped back to 100 percent. But the system’s financial picture hasn’t changed.

The growing disconnect between how hard many staff are working and the economic reality of the system isn’t unique to doctors. But physicians, most of whom have their compensation tied to individual productivity, may feel it more acutely. While there are no easy solutions, it’s critical to discuss this disconnect openly, rather than letting resentment fester under the surface.

The pandemic has brought to light the brittleness of health system and physician practice finances. Prescient systems will use this moment to work with their doctors to rethink practice and align compensation with the financial success of the system, while meeting doctors’ needs for stability and security.

 

 

340 organizations tell Congress to make telehealth permanent

https://www.healthcarefinancenews.com/news/340-organizations-tell-congress-make-telehealth-permanent?utm_source=SFMC&utm_medium=email&utm_campaign=NL-HFN-NewsDay-2020-07-01+-+20200629_101004+-+20200630_102918+-+20200630_181109+-+20200701_104543%e2%80%8b

Advocacy and Policy | Primary Care Collaborative

New report finds the growth of telemedicine visits has plateaued and accounts for a relatively small percentage of rebounding ambulatory care.

On Monday, 340 organizations signed a letter urging Congress to make telehealth flexibilities created during the COVID-19 pandemic, permanent. 

Those signing the letter include national and regional organizations representing a range of healthcare stakeholders in all 50 states, the District of Columbia and Puerto Rico.

Congress quickly waived statutory barriers to allow for expanded access to telehealth at the beginning of the COVID-19 pandemic, providing federal agencies with the flexibility to allow healthcare providers to deliver care virtually.

Stakeholders also want Congress to remove restrictions on the location of the patient to ensure that all patients can access care at home, and other appropriate locations; to maintain and enhance HHS authority to determine appropriate providers and services for telehealth; ensure federally qualified health centers and rural health clinics can furnish telehealth services after the public health emergency; and make permanent the Health and Human Services temporary waiver authority for future emergencies.

While federal agencies can address some of these policies going forward, the Centers for Medicare and Medicaid does not have the authority to make changes to Medicare reimbursement policy for telehealth under current law, stakeholders said.

In a statement separate from the letter to Congress, Lux Research Associate Danielle Bradnan said key concerns for legislators are broadband internet access, payer reimbursement and licensure barriers, since, currently, medical licenses are only valid for specific states.

WHY THIS MATTERS

If Congress does not act before the COVID-19 public health emergency expires, current flexibilities will disappear, according to stakeholders.

The PHE is scheduled to expire in July.

In a tweet late yesterday, Michael Caputo, the assistant secretary of the Department of Health and Human Services for public affairs, said HHS is expected to renew the PHE before it expires. It has already been renewed once.

THE LARGER TREND

The use of telehealth has skyrocketed under in-person restrictions under COVID-19.

Private health plans have followed suit, the letter said, resulting in a 4,300% year-over-year increase in claims for March 2020.

However, a new report from the Commonwealth Fund has found that the growth of telemedicine visits has plateaued and account for a relatively small percentage of rebounding ambulatory care services.

As states experiment with reopening – and re-closing – their economies in response to concerns around rising coronavirus cases, the report found that telemedicine visits have actually been declining since April.

 

 

 

 

Primary care physicians could take $15 billion hit due to COVID-19 in 2020

https://www.healthcaredive.com/news/primary-care-physicians-could-take-15-billion-hit-due-to-covid-19-in-2020/580600/

Dive Brief:

  • The financial impact on primary care practices due to the COVID-19 pandemic has been profound and will likely continue in the months ahead, according to a new study published in Health Affairs.
  • Visits of all types to medical practices declined 58% in March and April compared to the baseline average, and in-person patient encounters declined by 69%, the study found. Although visits are expected to have rebounded by June, volumes are still below pre-COVID-19 levels.
  • The drop in fee-for-service revenue for the 2020 calendar year is nearly $68,000 per physician, contributing to an estimated revenue decline of 12.5%. That’s a steep enough loss to threaten the financial viability of many practices. Losses to primary care practices nationwide could top $15 billion over the year — a number that could grow if the federal government reverts increased telemedicine payment rates.

Dive Insight:

Medical practices across the United States have been hit hard by the COVID-19 outbreak.

The new study by researchers from Harvard Medical School and the American Board of Family Medicine attempts to put a price tag on that hit by running a microsimulation for projected 2020 revenues based on volume data for general practices, general internal medicine practices, general pediatric practices and family medicine practices.

As a result, they concluded that the average revenue loss per practice per physician will be $67,774, even taking into account revenue generated by telemedicine visits, which did not make up for the massive loss of patient volume during the spring.

That loss could be cut to as little as $28,265 per full-time physician if other staff is furloughed and salaries are cut to the 25th percentile of such cuts that took place during the peak of the stay-at-home orders.

Some practices are also projected to have steeper losses. Rural primary care practices are projected to lose $75,274 per physician. Other studies have suggested that pediatric practices have been hit harder than other primary care fields. Some organizations, such as the American Medical Group Association, say revenue won’t rebound fully even next year.

The study also conducted various alternate scenarios for the remainder of 2020, including a second wave of COVID-19 in the fall. The researchers estimated that would cut patient volumes by about half as much as what occurred during the spring. However, the financial hit would deepen even further, reaching $85,666 per physician.

Altogether, the study projects primary care practices will lose $15.1 billion in fee-for-service revenue this year, not even accounting for a second wave of the coronavirus. The study’s authors note that “this loss would balloon substantially if telemedicine payment rates revert back to pre-COVID-19 levels towards the end of the year.”

The study concluded that while primary care physicians as a whole have not been as hard hit as the hospital sector, the services they provide in managing chronic diseases such as diabetes and as the port of entry for many into the healthcare system makes them too valuable to suffer sustained levels of financial damage.

 

 

 

Navigating a Post-Covid Path to the New Normal with Gist Healthcare CEO, Chas Roades

https://www.lrvhealth.com/podcast/?single_podcast=2203

Covid-19, Regulatory Changes and Election Implications: An Inside ...Chas Roades (@ChasRoades) | Twitter

Healthcare is Hard: A Podcast for Insiders; June 11, 2020

Over the course of nearly 20 years as Chief Research Officer at The Advisory Board Company, Chas Roades became a trusted advisor for CEOs, leadership teams and boards of directors at health systems across the country. When The Advisory Board was acquired by Optum in 2017, Chas left the company with Chief Medical Officer, Lisa Bielamowicz. Together they founded Gist Healthcare, where they play a similar role, but take an even deeper and more focused look at the issues health systems are facing.

As Chas explains, Gist Healthcare has members from Allentown, Pennsylvania to Beverly Hills, California and everywhere in between. Most of the organizations Gist works with are regional health systems in the $2 to $5 billion range, where Chas and his colleagues become adjunct members of the executive team and board. In this role, Chas is typically hopscotching the country for in-person meetings and strategy sessions, but Covid-19 has brought many changes.

“Almost overnight, Chas went from in-depth sessions about long-term five-year strategy, to discussions about how health systems will make it through the next six weeks and after that, adapt to the new normal. He spoke to Keith Figlioli about many of the issues impacting these discussions including:

  • Corporate Governance. The decisions health systems will be forced to make over the next two to five years are staggeringly big, according to Chas. As a result, Gist is spending a lot of time thinking about governance right now and how to help health systems supercharge governance processes to lay a foundation for the making these difficult choices.
  • Health Systems Acting Like Systems. As health systems struggle to maintain revenue and margins, they’ll be forced to streamline operations in a way that finally takes advantage of system value. As providers consolidated in recent years, they successfully met the goal of gaining size and negotiating leverage, but paid much less attention to the harder part – controlling cost and creating value. That’s about to change. It will be a lasting impact of Covid-19, and an opportunity for innovators.
  • The Telehealth Land Grab. Providers have quickly ramped-up telehealth services as a necessity to survive during lockdowns. But as telehealth plays a larger role in the new standard of care, payers will not sit idly by and are preparing to double-down on their own virtual care capabilities. They’re looking to take over the virtual space and own the digital front door in an effort to gain coveted customer loyalty. Chas talks about how it would be foolish for providers to expect that payers will continue reimburse at high rates or at parity for physical visits.
  • The Battleground Over Physicians. This is the other area to watch as payers and providers clash over the hearts and minds of consumers. The years-long trend of physician practices being acquired and rolled-up into larger organizations will significantly accelerate due to Covid-19. The financial pain the pandemic has caused will force some practices out of business and many others looking for an exit. And as health systems deal with their own financial hardships, payers with deep pockets are the more likely suitor.”

 

 

 

 

Telehealth could grow to a $250B revenue opportunity post-COVID-19: analysis

https://www.fiercehealthcare.com/tech/telehealth-could-grow-to-a-250b-revenue-opportunity-post-covid-mckinsey-reports

virtual visit

With the acceleration of consumer and provider adoption of telehealth, a quarter of a trillion dollars in current U.S. healthcare spend could be done virtually, according to a new report.

During the COVID-19 pandemic, consumer adoption of telehealth has skyrocketed, from 11% of U.S. consumers using telehealth in 2019 to 46% of consumers now using telehealth to replace canceled healthcare visit, according to consulting firm McKinsey & Company’s COVID-19 consumer survey conducted in April.

McKinsey’s survey also found that about 76% of consumers say they are highly or moderately likely to use telehealth in the future. Seventy-four percent of people who had used telehealth reported high satisfaction.

Health systems, independent practices, behavioral health providers, and other healthcare organizations rapidly scaled telehealth offerings to fill the gap between need and canceled in-person care. Providers are ready for the shift to virtual care: 57% view telehealth more favorably than they did before COVID-19 and 64% are more comfortable using it, according to McKinsey’s recent provider surveys.

Pre-COVID-19, the total annual revenues of U.S. telehealth players were an estimated $3 billion, with the largest vendors focused on virtual urgent care.

Telehealth is now poised to take a bigger share of the healthcare market as McKinsey estimates that up to $250 billion, or 20% of all Medicare, Medicaid, and commercial outpatient, office, and home health spend could be done virtually.

The consulting firm looked at anonymized claims data representative of commercial, Medicare, and Medicaid utilization.

The company’s claims-based analysis suggests that approximately 20% of all emergency room visits could potentially be avoided via virtual urgent care offerings, 24% of healthcare office visits and outpatient volume could be delivered virtually, and an additional 9% “near-virtually.”

Up to 35% of regular home health attendant services could be virtualized, and 2% of all outpatient volume could be shifted to the home setting, with tech-enabled medication administration.

Many of the dynamics that have helped to expand telehealth adoption are likely to be in place for at least the next 12 to 18 months, as concerns about COVID-19 remain until a vaccine is widely available.

Going forward, telehealth can increase access to necessary care in areas with shortages, such as behavioral health, improve the patient experience, and improve health outcomes, McKinsey reported.

Providers and patients are concerned that recent federal and state policies expanding access to telehealth will be rolled back once the emergency period ends.

Industry groups, including the College of Healthcare Information Management Executives (CHIME), are calling on lawmakers to ensure the changes enacted by Congress and the administration become permanent.

McKinsey’s research indicates providers’ concerns about telehealth include security, workflow integration, effectiveness compared with in-person visits, and the future for reimbursement.

“We call on Medicare and all other insurers to continue to fund telehealth programs and work collaboratively on coverage and coding to lessen provider burden. We cannot go back to pre-COVID telehealth; instead, we must go forward. Patients will demand it and providers will expect it,” CHIME CEO and President Russell Branzell said in a recent statement.

Telehealth also is drawing bipartisan support. Senator Marsha Blackburn, R-Tenn., urged Congress to “continue to support this expansion and codify the administration’s changes to support the health needs of the American people,” in a recent news release.

Rep. Robin Kelly, D-Illinois, is introducing a bill directing HHS Secretary Alex Azar to oversee a telehealth study looking at the technology’s impact on health and costs, Politico reported in its newsletter today.

 

Taking advantage of the telehealth opportunity

Healthcare providers and payers will need to take action to ensure the full potential of telehealth is realized after the crisis has passed, according to McKinsey.

There continue to be challenges as providers cite concerns about telehealth include security, workflow integration, effectiveness compared with in-person visits, and the future for reimbursement. There also is a gap between consumers’ interest in telehealth (76%) and actual usage (46%). Factors such as lack of awareness of telehealth offerings and understanding of insurance coverage are some of the drivers of this gap.

“The current crisis has demonstrated the relevance of telehealth and created an opening to modernize the care delivery system,” McKinsey consultants wrote. “Healthcare systems that come out ahead will be those who act decisively, invest to build capabilities at scale, work hard to rewire the care delivery model, and deliver distinctive high-quality care to consumers.”

McKinsey outlined steps industry stakeholders should take to drive the growth of telehealth.

 

Payers: Health plans should look to optimize provider networks and accelerate value-based contracting to incentivize telehealth. Align incentives for using telehealth, particularly for chronic patients, with the shift to risk-based payment models.

Payers also should build virtual health into new product designs to meet changing consumer preferences, This new design may include virtual-first networks, digital front-door features (for example, e-triage), seamless “plug-and-play” capabilities to offer innovative digital solutions, and benefit coverage for at-home diagnostic kits.

 

Health systems: Hospitals and health systems should accelerate the development of an overall consumer-integrated “front door.” Consider what the integrated product will initially cover beyond what currently exists and integrate with what may have been put in place in response to COVID-19, for example, e-triage, scheduling, clinic visits, record access.

Providers also should build the capabilities and incentives of the provider workforce to support virtual care, including, workflow design, centralized scheduling, and continuing education. And, health systems need to take steps to measure the value of virtual care by quantifying clinical outcomes, access improvement, and patient/provider satisfaction. Include the potential value from telehealth when contracting with payers for risk models to manage chronic patients, McKinsey said.

 

Investors and health technology firms: These players also can support the new reality of expanded telehealth services. Technology firms should consider developing scenarios on how virtual health will evolve and when, including how usage evolved post-COVID-19, based on expected consumer preferences, reimbursement, CMS and other regulations.

Investors also should develop potential options and define investment strategies based on the expected virtual health future. For example, combinations of existing players/platforms, linkages between in-person and virtual care offerings and create sustainable value. Investors and technology companies also can identify the assets and capabilities to implement these options, including specific assets or capabilities to best enable the play, and business models that will deliver attractive returns.

 

 

 

 

Amwell CEOs on the telehealth boom and why it will ‘democratize’ healthcare

https://www.fiercehealthcare.com/tech/amwell-ceos-telehealth-boom-will-democratize-healthcare?mkt_tok=eyJpIjoiWmpobE5XVmlaRGd6T0dFdyIsInQiOiJsQmxnbVNxNVlISVNkczJIZkJXb3ZFZG9tVlpMblZ1XC9oVVB6SlRINzNhOXE4MWQzNk1cL3JTaDlcL2l0MGdhSnk0NUtqY1RzdThCN1wvZ1ZoVUxqOHJwZFJcL1wvK3FtS0o5NFwvSHA0WHhTUnhVNnY3bk5RNmhRQTdxYzYwclhYN3JTRW8ifQ%3D%3D&mrkid=959610

Amwell CEOs on the telehealth boom and why it will 'democratize ...

The COVID-19 pandemic has catapulted the telehealth industry forward by decades in a matter of months, according to Amwell’s Roy Schoenberg.

That not only benefits the Amwell’s business, but it’s a win for patients, said Schoenberg, who serves as the company’s president and co-CEO.

“We are going to see an enormous amount of change, nothing short of a revolution, going forward,” he told Fierce Healthcare.

Roy and his brother Ido Schoenberg have been telehealth advocates for more than a decade since launching Amwell, formerly American Well, in 2006. The Boston-based telehealth company works with more than 240 health systems comprised of 2,000 hospitals and 55 health plan partners with over 36,000 employers, reaching over 150 million lives.

Like other virtual care companies, Amwell has seen skyrocketing demand for its services during the COVID-19 pandemic as stay-at-home orders and social distancing guidelines prevented many patients from visiting doctors in person. Shares in public digital health companies like Teladoc and Livongo have grown by double digits during the health crisis.

The momentum around telehealth also has attracted investors. The company recently raised $194 million in a series C funding round.

Amwell also is gearing up to go public later this year, according to CNBC’s Christina Farr and Ari Levy. The company confidentially filed for an IPO earlier this week and has hired Goldman Sachs and Morgan Stanley to lead the deal, Farr and Levy reported last week, citing people who asked not to be named because the plans have not been announced.

The company declined to comment on the CNBC report.

Before the COVID-19 pandemic began, Amwell was providing an average of 5,000 telehealth visits a day. That has jumped to 45,000 to 50,000 virtual visits a day due to the coronavirus, said Ido Schoenberg, who serves as chairman and co-CEO. 

“We saw 30 times, 40 times higher volumes and we have clients that had 2% to 3% of their patient volume online that now have 75% of visits online,” he said. “It’s truly incredible. The number of active providers on our platform grew seven times over in two months.”

As visits surged, technology companies struggled to keep up with demand, and patients reported long wait times for virtual visits on some platforms.

Roy Schoenberg acknowledged Amwell also faced challenges rapidly scaling its technology and services almost overnight as it was “thrown into the center stage of trying to save the world.”

The company leverages automation for processes such as onboarding physicians, credentialing, licensing, and working with health plans and that capability proved critical to scaling its services, the executives said.

“We needed to allow 40,000 to 50,000 physicians to come on to our system and begin to use it. If this was a manual process, it would have been broken,” Roy Schoenberg said.

Regulatory barriers to telehealth also quickly fell away, at least temporarily. The Centers for Medicare and Medicaid Services and commercial health plans have expanded access to telehealth by offering payment parity for many telehealth services for the first time.

While questions remain about what regulatory flexibilities will remain in place to support the ongoing demand for telehealth, Amwell executives believe virtual care has proven its value to providers, payers and patients.

CMS will likely tighten up some of the relaxed requirements around telehealth which is a “fiscally responsible approach,” Roy Schoenberg said.

“At the end of the day, even though the government tends to be a little bit slow, it gravitates to where the value is. How long will it take for the payment structure to retract and then expand, that’s anyone’s guess. We have an election year coming in. Who knows what that is going to do? There may be some changes, but I think overall, the genie is out of the bottle, the toothpaste is out of the tube, or whatever phrase you want to use,” he said.

The executives never doubted that telehealth would, at some point, reach the mainstream. Now that it’s happened, health systems and patients have become advocates for the technology and that will also put pressure on CMS and commercial payers to continue to support it, they said.

The executives now see an opportunity for Amwell to use its platform to expand the reach of healthcare to more patients. There is a growing industry of telehealth providers, device makers, and technology-enabled disease management companies that will enable digital home healthcare services, they said.

“What we built is something way bigger than a video conference between doctor and patient, which you can easily do using Zoom or FaceTime,” Ido Schoenberg said.

Digital connectivity will enable providers to gather health data on patients from wearables and devices to better understand gaps in care, get an overall picture of patients’ health and then provide more effective interventions, all without patients leaving their living rooms. The combination of telehealth and remote devices will enable elderly, frail patients to receive care at home, where they want to be, rather than being moved to a skilled nursing facility, they said.

“It’s about the ability to democratize healthcare and make great care available to many more people that today don’t always have access to it,” Ido Schoenberg said.

Roy Schoenberg added, “These are the opportunities opening fast and furious in front of us and the promise is to make healthcare less painful as an individual experience. That’s the value proposition.”

 

 

 

 

A deeper look at a new(ish) model of primary care delivery

https://mailchi.mp/f2774a4ad1ea/the-weekly-gist-may-22-2020?e=d1e747d2d8

Direct Primary Care: What Does it Mean for Independent and ...

Cometh the moment, cometh the care model. That’s one way of interpreting a new study commissioned by the Society of Actuaries, and performed by Milliman researchers, that evaluates the direct primary care (DPC) model. Often touted by advocates as a way to “cut out the middleman” and allow for greater patient-physician engagement, DPC is membership-model primary care, with a monthly or annual fee paid by the patient (or their employer) for unlimited access to a range of services for no additional out-of-pocket payment, and without billing insurance for care delivery.

In the study, Milliman reviewed existing literature, conducted a survey of nearly 200 DPC practices, and performed an in-depth analysis of one employer’s DPC offering. Their findings: higher physician satisfaction; smaller panel sizes (on average 445 patients per practice); and statistically significant decreases in overall demand for services (down 12.6 percent) and ED utilization (down 40.5 percent). All that for a monthly fee of between $65 and $85 per adult patient—resulting in a slight net increase in employer benefit costs (1.3 percent) but higher enrollee satisfaction.

The Milliman study is one of the first detailed analyses of the potential benefits of this newish care model, and the results suggest that there is promise for the approach. Critics rightly raise some doubts: could there could ever be enough physician supply to make this model work at national scale? And does the model encourage cherry-picking of more affluent, lower-utilizing patients, making the remaining risk pool more costly to cover?

But in a post-COVID world, with primary care doctors increasingly concerned about revenue stability, and employers looking to control spend (and searching for sweeteners to offset a potential shift to narrower referral networks), the model has the potential to play a greater role in future benefit design. Especially if coupled with a (potentially lower-cost) virtual-first approach, DPC could prove an attractive option for physicians and patients to move away from the fee-for-service, productivity-driven primary care model.

 

 

Charting the rebound of physician office visits

https://mailchi.mp/f2774a4ad1ea/the-weekly-gist-may-22-2020?e=d1e747d2d8

MultiBrief: Telehealth is keeping doctors, patients connected in ...

As patients begin to return to doctors’ offices, we were intrigued to read an analysis out this week from the Commonwealth Fund that provides a first glimpse into the pace of the recovery. Researchers from Harvard University and healthcare technology company Phreesia analyzed data from 12M visits at over 50,000 physician practices, finding that in-person visits had declined nearly 70 percent by mid-April, compared to pre-pandemic levels.

Behavioral health providers, medical specialists and primary care practices maintained the most volume, and procedural specialists were the hardest hit. Many practices deployed telemedicine quickly, but even with those added encounters, total visits were still down by nearly 60 percent. While visits are starting to return, it’s likely that physician practices are in for a long, slow rebound. Telemedicine as a percentage of all visits peaked in late April, and by mid-May, in-person visits had reached 55 percent of pre-pandemic levels.

Even if virtual volumes pull back from their COVID high, we’re likely to see telemedicine play a much more expansive role moving forward. Dr. Rushika Fernandopulle, CEO of Iora Health, shared his company’s learnings from their COVID-19 response, predicting that ultimately 70-80 percent of physician encounters could be virtual, necessitating a need to reorganize care delivery around populations, instead of practices.

Expect the next year to be a reckoning as changes in payment and regulations, combined with a heated marketplace for virtual care, continue to shift the balance between in-person and virtual care.

 

 

Facing a reckoning on physician compensation?

https://mailchi.mp/f4f55b3dcfb3/the-weekly-gist-may-15-2020?e=d1e747d2d8

Doctor salaries have shot up 30% in past decade over fears of ...

As health systems take tentative steps to resume non-emergent procedures and office visits, it’s increasingly clear that volume will not quickly return to pre-COVID levels. According to a health system chief physician executive we spoke with this week, this has forced medical group leadership to reevaluate physician compensation, at least for the rest of 2020.

“We’ve kept our doctors pretty much whole for the past three months,” she said, “but given the losses we’re facing for the rest of the year, we can’t keep it up much longer.” We’ve had a flurry of calls in the past two weeks with systems in the same position. Most of their doctors are primarily paid based on their productivity. “We all loved the upside opportunity,” mused one physician leader, “but we never thought something could happen that would completely wipe us out.”

This point got us wondering whether we might be seeing the beginning of the end of RVU-based physician compensation, as physicians seek greater stability and safety. But moving to a salary-driven model is far from easy. How much upside are doctors willing to trade off for security? The survey data used to benchmark compensation, based on last year’s business model, is essentially irrelevant—and likely will be for next year as well. According to one consultant, “Given that there’s no consistency in volume or compensation strategy, the 2020 data will be garbage, too.” Not to mention, dramatically shifting the way doctors are paid has huge cultural and operational ramifications.

There are no easy answers, but we think this conversation about the future of compensation, and the larger issues it raises about doctors’ relationship to, and role in, the health system, is long overdue. One executive shared his system’s plan to pay their doctors 85 percent of their 2019 compensation through the summer. He’s not sure yet what the other side of August looks like. “Maybe we’ll have physicians who want to continue to be paid on productivity like a car salesman. But if you want that kind of upside now, the safety net likely won’t be there the next time.” However, he hopes this experience “provides a reset point that gets us to a more sustainable—and professional—way of working together for the future.”