Michael Cuffe, MD, president and chief executive officer, physician services at HCA Physician Services Group in Brentwood, Tennessee, recently spoke at the Medical Group Management Association’s annual conference and highlighted the impacts and implications of value-based care for primary care physicians and smaller practices in particular.

It’s a decidedly mixed bag, according to Cuffe, with both tangible benefits and clear risks.

“It makes sense to pursue risk if you’re a clinician looking for ways to provide better comprehensive care – and the fee-for-service framework hasn’t created that ability.”

There are added costs for physician practices to be successful in value-based care, including IT infrastructure and care management resources. These incremental costs could be prohibitive for smaller practices.

“Smaller physician practices are particularly vulnerable to [financial] risk, and there are upfront costs to consider: electronic health records support, codified documentation and ideally asynchronous care tools.”

As physician practices begin to take risk for populations, they should be careful about which health system they choose to align with in their communities,”since the highest cost platform is the hospital, specifically the emergency room.”

Conventional wisdom has held that PCPs are not receptive to value-based payment models, largely due to their aversion to taking on risk. Cuffe’s comments suggest how this thinking may change over time. “Moving to value-based care is not inappropriate,” he said, but it requires a “new approach.”