Paying for performance

Paying Doctors for Patient Performance from the NYT.

Pay-for-procedure (fee-for-service) reimbursement has, according to many, corrupted the health care system. It has made health care a “business” where physicians care more about the insurance billing code for a procedure than the actual procedure itself. Physicians have become more procedure-happy and order unnecessary tests, which has led to a culture of overuse.

I’m not making any excuses for such practices, but I feel like I understand at least one reason why physicians may feel the need to do this: malpractice. Malpractice is a huge issue and I think a lot of physicians order extra tests to not only make sure they are not sued, but in the event they are, they can’t be pegged for “negligence” for failing to order a test.

Then again, I think there is so much negativity surrounding the pay-for-procedure model that people assume that pay-for-performance will solve all our problems. But there are many variables that depend on human error – or should I say, non-error – which, from an engineering standpoint, always complicates the interpretation of the data. As this article points out, a lot of it depends on the patient: their socioeconomic background (some of these families of 4 have a $200 for food an ENTIRE MONTH. How can we tell them to buy fresh fruits and vegetables when processed foods are so much cheaper?), ethnicity (which may pre-dispose them for a certain disease), age, language barriers, health literacy barriers (which depends on level of education, language barriers etc), and compliance.

I would also like to add that physicians may now have the incentive to pick and choose the healthiest and/or the most compliant patients. A refusal to treat the sickest or uninsured patients would exacerbate the disparity in health care already faced by our nation.

I completely agree with the article when it says that this model of reimbursement needs a lot more evaluation. Of course, my solution is to follow Mayo Clinic’s lead and go with salaries….but that’s just my fierce loyalty and belief in Mayo Clinic speaking…I don’t think I would be able to convince every medical professional that that is the best model of payment.

EDIT: another response to the NYT article from DB’s Medical Rants.

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