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

Quality is this physician’s religion

Kjell Benson, MD
Physician
June 23, 2017
Share
Tweet
Share

My hospitalist medical group consists of as great collection of atheists, agnostics, and skeptics as you will ever find.  But we all agree that quality is our religion.  We believe to our last breath that patient care is sacred and an invaluable gift.  And so, as with all faith, there is no halfway.  You believe, or you stand around scratching your head asking what those other fools are worshipping.  Just so with quality; there is no 50 percent attempt.  You either believe that providing the best quality care is what you devoted your life to, or you are left adding up check boxes in the EMR to calculate your “quality incentive.”

Hospital administrators increasingly want to “align” their payer reimbursement to physician pay, calling it pay-for-performance, or variable compensation. Payers tie reimbursement to metrics such as readmissions, DVT prophylaxis, and many, many others through programs such as MIPS, MACRA and IPPS.  “Why shouldn’t doctors be reimbursed along the same lines?” they ask.

Payers devised incentive payments because of the business case for them: Improvement on these metrics means globally better health and less cost, whether that be through private insurance or Medicare.  By focusing on these population measures, we are surely improving the global health of Americans.  But lost in this headlong rush towards alignment is the recognition that physicians, the best physicians at least, the ones that you want caring for you, took an ethical oath to care for their patients and that means quality is an ethical issue, not financial. Doctors harbor a secret golden spark, deep inside, which is our religion: adherence to the sanctity of the physician-patient relationship with its own inherent “quality.”

Clinicians increasingly are employed within a business structure, and are not insensitive to business concerns.  Doctors respond to financial incentives, as do all humans.  Capitalism works better than communism.  But, the administrator’s job is to translate a clinical service into a profitable business strategy.  Nothing in that job description says incentives must be “aligned.”  Administration negotiates reimbursement rates with insurance companies, yet doctors are not aligned by preferentially admitting only those with the highest reimbursement.  The hospital is paid more by documenting every single little patient comorbidity, thereby boosting the “case mix index”; yet doctors are not paid more for a note that includes more comorbidities.  God forbid the day all our incentives are aligned!  The business aspect of medicine follows many dictates that the clinical side does not; “alignment” is not a given.  The best leadership creates a transparent environment that allows clinicians freedom to operate based on the best ethical concern for the patient.  “Aligning incentives” is actually only code for “we have failed to create a business plan that supports a practice environment and so are asking you to do it for us.”

Clearly, American medicine is far from perfect, and even faith requires cultivation. Good medical leadership can help groups improve their quality.  Medical directors should continuously review quality issues, groups can have mechanisms for internal review, and some groups even transparently publish various metrics. The mechanisms for quality improvement are as varied as the types of religious faith.  But no religious faith requires payment.

Paying for faith via “indulgences” was tried by the medieval church.  The result was Martin Luther’s Ninety-Five Theses and the Protestant Reformation.  Well, let these be my theses posted on the All Saints’ Church door: “Do not try to pay me for quality!”  I will rebel and take back my ethical practice of medicine.  Join me in the Medical Reformation. Doctors, find practices that value you for your faith!  Administrators, rip up those compensation plans, and hire a team that believes.  The next time I myself need a doctor, the first thing I will ask is, “Are you helping me because of your Hippocratic Oath, or because of your incentive plan?” I simply won’t go see the robotic box-checkers anymore.

The Church no longer allows payment for indulgences, let’s not start doing it in medicine.

Kjell Benson is a hospitalist who blogs at The Consolation of Philosophy.

Image credit: Shutterstock.com

Prev

Doctors and cops can fight mistrust the same way

June 22, 2017 Kevin 5
…
Next

Searching online from a patient perspective can make you a better doctor

June 23, 2017 Kevin 0
…

Tagged as: Hospital-Based Medicine

Post navigation

< Previous Post
Doctors and cops can fight mistrust the same way
Next Post >
Searching online from a patient perspective can make you a better doctor

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Kjell Benson, MD

  • Are we medicalizing everything?

    Kjell Benson, MD
  • 5 steps to create medical quality without trying

    Kjell Benson, MD
  • Doctors, we need to start making our own tools

    Kjell Benson, MD

Related Posts

  • A physician’s addiction to social media

    Amanda Xi, MD
  • 3 ways physician-pharma partnerships are improving quality of care

    Jack Pinney, MD
  • Quality measures have gotten ahead of the science of quality measurement

    Peter Ubel, MD
  • How a physician keynote can highlight your conference

    Kevin Pho, MD
  • Chasing numbers contributes to physician burnout

    DrizzleMD
  • The black physician’s burden

    Naomi Tweyo Nkinsi

More in Physician

  • The hidden incentives driving frivolous malpractice lawsuits

    Howard Smith, MD
  • Mastering medical presentations: Elevating your impact

    Harvey Castro, MD, MBA
  • Marketing as a clinician isn’t about selling. It’s about trust.

    Kara Pepper, MD
  • How doctors took back control from hospital executives

    Gene Uzawa Dorio, MD
  • How art and science fueled one woman’s path to medicine

    Amy Avakian, MD
  • In a fractured world, Brian Wilson’s message still heals

    Arthur Lazarus, MD, MBA
  • Most Popular

  • Past Week

    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
  • Recent Posts

    • It’s time for pain protocols to catch up with the opioid crisis

      Sarah White, APRN | Conditions
    • First impressions happen online—not in your exam room

      Sara Meyer | Social media
    • How locum tenens work helps physicians and APPs reclaim control

      Brian Sutter | Policy
    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician
    • Why what doctors say matters more than you think [PODCAST]

      The Podcast by KevinMD | Podcast
    • How Mark Twain would dismantle today’s flawed medical AI

      Neil Baum, MD and Mark Ibsen, MD | Tech

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 5 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

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
  • Recent Posts

    • It’s time for pain protocols to catch up with the opioid crisis

      Sarah White, APRN | Conditions
    • First impressions happen online—not in your exam room

      Sara Meyer | Social media
    • How locum tenens work helps physicians and APPs reclaim control

      Brian Sutter | Policy
    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician
    • Why what doctors say matters more than you think [PODCAST]

      The Podcast by KevinMD | Podcast
    • How Mark Twain would dismantle today’s flawed medical AI

      Neil Baum, MD and Mark Ibsen, MD | Tech

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

Quality is this physician’s religion
5 comments

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

Loading Comments...