Value-Based Reimbursement: Impact of Curtailing Physician Autonomy in Medical Decision Making

AJR Am J Roentgenol. 2016 Feb;206(2):276-9. doi: 10.2214/AJR.15.15370.


Objective: In this article, we define value in the context of reimbursement and explore the effect of shifting reimbursement paradigms on the decision-making autonomy of a women's imaging radiologist.

Conclusion: The current metrics used for value-based reimbursement such as report turnaround time are surrogate measures that do not measure value directly. The true measure of a physician's value in medicine is accomplishment of better health outcomes, which, in breast imaging, are best achieved with a physician-patient relationship. Complying with evidence-based medicine, which includes data-driven best clinical practices, a physician's clinical expertise, and the patient's values, will improve our science and preserve the art of medicine.

Keywords: breast cancer screening; breast imaging; outcome metrics; physician autonomy; value; value-based reimbursement; women's imaging.

MeSH terms

  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / economics
  • Clinical Competence
  • Clinical Decision-Making*
  • Female
  • Humans
  • Outcome and Process Assessment, Health Care / economics
  • Physician-Patient Relations
  • Professional Autonomy
  • Quality of Health Care / economics*
  • Radiology / economics*
  • Radiology / organization & administration
  • Reimbursement Mechanisms / economics*
  • Value-Based Purchasing / economics*