We routinely tip our waitress at the local diner, and our barber…er, uh Hair Stylist, even the pizza delivery guy. But how much do we tip our physician when we’ve recovered from the surgery, or just stayed healthy?
Of course, I ask this with tongue firmly in cheek, but I was prompted to bring this up because of an article over at Fox News. Apparently, physicians who participate in the “Bridges To Excellence” program are eligible for cash bonuses based on the health of their patients.
The idea is that, if docs can keep their patients healthy, they’ll lower overall health care costs. Which makes sense. Of course, it hearkens back to capitation plans (e.g. staff model HMO) which actually penalize physicians who have negative outcomes. This approach has had mixed success; apparently sticks don’t work as well as carrots.
As one can imagine, not everyone who learns about this arrangement is a fan:
"It's disturbing that the only way we can get physicians to do the right thing for their patients is by paying them money."
So says Arthur Levin from the Center for Medical Consumers, a non-profit advocacy organization active in both statewide and national efforts to improve the quality of health care.
I find this kind of naiveté refreshing, if misplaced. Last I looked, physicians are human (well, excepting EMH, for all you Voyager fans), and respond well to financial incentives. What difference does it make “why” a given doctor is motivated to keep his patients well? What’s important is that his are.
There is one valid concern mentioned in the article, but it seemed as if it was an afterthought, and wasn’t fully explicated: “Critics fear an incentive program may encourage doctors to treat only the healthiest patients in order to get the financial reward.” Isn’t that the same argument, though, that critics have lobbed at Consumer Driven Health Care? I’m not saying it isn’t true, but I would love to see some facts to support the thesis.
Interestingly, Medicare is testing this out, as well. That’s promising: anything that would potentially help lower the costs of Medicare can’t be all bad.
Interesting idea, and I’ll be keeping an eye out for more information on it.
UPDATE: Welcome Grand Rounds visitors! Please take a look around, and feel free to leave a comment (or three).
This practice may not be as prevalent as it once was, but HMO's took a lot of heat a few years back for giving bonuses to docs who minimized the use of facilities. Generate more profit for the HMO, earn a bonus.
ReplyDeleteThe downside of managed care is the tendancy toward "bean-counter" medicine. Thanks in part to litigation the pendulum has swayed back toward dead center and there is more of a balance between cost-effective medicine and patient care.
Sounds a lot like the capped health plans:
ReplyDeleteI always chuckle when I hear the story of here to place your patient recruitment office for capped plan patients?
"A few flights up"
That way, only the healthy ones will make it to join.
> "It's disturbing that the only way we can get physicians to do the right thing for their patients is by paying them money." --- Arthur Levin
ReplyDeleteI think you're much too polite. Said ASS needs to get a series of barium enemas followed by a laryngectomy and dual amputations at the elbows. Then more barium enemas...
"Doing Right" by your patients can take more or less time. By what right does a patient demand the doctor's time be spent dealing with HIS problem and not someone else's? By remuneration, of course. One hopes money is not the sole reason a doctor becomes a doctor, but certainly, if you want ANY human to put in the extra effort to do a job particularly WELL, you have to be willing to reward them -- to compensate them -- for the extra time devoted to that and not, say, golfing or dandling babies on their knee or hang-gliding.
Mr. Levin, the socialist swine, thinks he has the right to suck at the doctor's life force (which IS what happens when you take someone's time! Time on earth is ALL you really have in life) and give nothing in return. How considerate of him.
MORE ENEMAS!
:-/
Nope, not a doctor, not even in the med profession -- just someone with a clue.
The *real* problem with this planet is too much tiger food and not enough tigers.
Hello! Blog surfing(as usual) and I found you guys. Nice feeling here. I'll come back . Keep up more stuff about Dental Health, please.
ReplyDeleteAll the best, Dental Health