Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The precarious peril of pay-for-performance

Ish Stevens, MD
Physician
October 22, 2016
Share
Tweet
Share

As a primary care pediatrician, I am often on the front line of mental health care. Since child psychiatric referral services are sparse and overloaded, I often have to initiate counseling for anxiety in many of my patients. One thing that I have learned is that you can help someone with anxiety in a tremendous way by getting them to recognize a simple fact: It is counterproductive to worry about things that we cannot change. We need to acknowledge the things that we can change, the things that we have control over, and recognize that we cannot control everything. This simple truth can lift a tremendous weight.

The new normal for physicians entails that our livelihood will be increasingly based on things that we cannot control, thus increasing the anxiety level of an already frazzled profession. I am an advocate for complex case management: I think that it is wasteful to not coordinate resources in the care of a complicated patient. The problem is that, as pediatricians, the vast majority of our patients do not have multiple chronic illnesses and do not fit a paradigm of complex case management. They do, however, have some pretty “non-algorithmic” things happen to them that do not fit seamlessly into a treatment paradigm. As a primary care pediatrician in Eastern Kentucky, I have a great deal of patients whose parents prenatally chose to expose their developing infant to harmful substances and who postnatally continue to make unhealthy choices, despite caring and compassionate counseling.

This concern extends to physicians who take care of older patients that refuse to quit smoking, or refuse to take prescribed medications regularly, etc. At some point, we as a society must acknowledge that there are consequences for our actions. However, we seem to want the freedom to make whatever choices we want and to have someone else bear the burden of the consequences.

Imagine that your local service station was contracted on a capitated basis to provide for your vehicle service needs. The station takes great care of your vehicle (and has extended service hours to accommodate your busy schedule!), but you choose to fill the gas tank with dirty creek water and to randomly shift into reverse while cruising along. Is it the station’s global package responsibility to fund and staff an educational team to train you how to take proper care of your vehicle? Or should you bear at least a modicum of responsibility for your irresponsible behavior?

In what I can survey, there is no mention of personal responsibility in the new normal; everything is someone else’s fault. Our motto should not be “the patient is always right” but instead should be “we will always do what is right for the patient.” This can lead to some uncomfortable discussions, that even though artfully and thoughtfully delivered by an actively listening physician, some patients will not find to their liking and respond with negative customer satisfaction surveys.

Another concern with rewarding physicians for having healthy patients is that many physicians will not want to take care of really sick patients because these cases will hurt their numbers. So when will the very patients who desperately need a medical home require care, where will they go? To the already overloaded ER to receive fragmented care. The same ER bound by EMTALA laws to provide a screening exam or face penalties. Then, when the visit is judged retrospectively to be non-emergent, the ER is reimbursed a non-sustainable rate. This is killing rural hospitals. But I get the impression that flyover country doesn’t matter much to the powers that be. This new normal looks oddly abnormal to me.

Ish Stevens is a pediatrician.

Image credit: Shutterstock.com

Prev

Defiance will inspire progress: Physicians should not surrender at any cost

October 22, 2016 Kevin 39
…
Next

A medical student realizes how he could change the system

October 22, 2016 Kevin 3
…

Tagged as: Pediatrics

Post navigation

< Previous Post
Defiance will inspire progress: Physicians should not surrender at any cost
Next Post >
A medical student realizes how he could change the system

ADVERTISEMENT

Related Posts

  • Pay for performance: Have we gotten what we’ve paid for?

    Joshua Liao, MD
  • If we don’t pay now to vaccinate our children, they will pay later

    Peter Ubel, MD
  • When physician pay packages become hospital kickbacks

    Jordan Rau
  • Close the gender pay gap in medicine

    Linda Girgis, MD
  • It is time to make the unvaccinated pay their fair share

    Hayward Zwerling, MD
  • A physician’s addiction to social media

    Amanda Xi, MD

More in Physician

  • Why Canada is losing its skilled immigrant doctors

    Olumuyiwa Bamgbade, MD
  • Why doctors are reclaiming control from burnout culture

    Maureen Gibbons, MD
  • Why screening for diseases you might have can backfire

    Andy Lazris, MD and Alan Roth, DO
  • Why “do no harm” might be harming modern medicine

    Sabooh S. Mubbashar, MD
  • International doctors blocked by visa delays as U.S. faces physician shortage

    Arthur Lazarus, MD, MBA
  • How I redesigned my life as a physician without abandoning medicine

    Ben Reinking, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician
    • How organizational culture drives top talent away [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician
    • How organizational culture drives top talent away [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The precarious peril of pay-for-performance
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...