Over the past decade, there has been yet another debate about whether pay-for-performance, the notion that the amount you get paid is tied to some measure of how you perform, “works” or not. It’s a silly debate, with proponents pointing to the logic that “you get what you pay for” and critics arguing that the evidence is not very encouraging. Both sides …
One way to think correctly about P4P programs
California doesn’t have enough doctors to provide healthcare to newly insured patients.
California state senator Ed Hernandez asks, “What good is it if they [state citizens] are going to have a health insurance card but no access to doctors?”
Wait. Health care insurance doesn’t mean that patients will have access to health care? Where have I heard that being said for more than 3 years?
The government is going to …
Providers who want the authority of doctors: Let them have it
From 1974 to 1982, a group of researchers conducted the RAND Health Insurance Experiment. In lay terms, what they did was assign people to different levels of insurance coverage, with a particular focus on the amount of co-payments, co-insurance, and deductibles that people had to pay, and then they observed their use of the health care system. As you might expect, those who had to pay more out of their …
Expanding Medicaid and cost sharing: A recipe for disaster?
Over the past several months, the state of Oregon has been pursuing an aggressive approach to solving the healthcare crisis that many states are dealing with.
A couple of years ago Oregon was facing a $2 billion deficit in their Medicaid program, with few solutions to repair the situation. The governor was reluctant to take the obvious step of cutting doctors’ pay for …
Look to Oregon to see if Obamacare will succeed
Should marijuana be legal, for either medical or recreational use? I think the best initial answer to this is: It’s a crummy question! We are good at those.
It’s a crummy question, because it calls for answers based on unsubstantiated opinion. Answering it does not invoke or even encourage any relevant evidence, or precedent. So what would a better question be? How about: On what basis should any particular substance be …
The path to data driven public policy: Ask the right questions first
Cleveland and northeast Ohio are not hospitable to private practice medicine. I should know. I’m one of them. Private practice is fading as health care reform suffocates it by design. When this occurs, the public will have lost physicians who, in my view, have practiced patient advocacy and service at a higher level than our employed counterparts.
Keep in mind that the first half of my professional career was spent as …
Reform is suffocating private practice by design
On January 7, 2013, a federal appeals court rejected six Georgia primary care physicians’ (PCPs) challenge to the Centers for Medicare and Medicaid Services’ (CMS) 20-year, sole-source relationship with the secretive, specialist-dominated federal advisory committee that determines the relative value of medical services. The American Medical Association’s (AMA) Relative Value Scale Update Committee (RUC) is, in the court’s view, not subject to …
The RUC survives and now our health system is worse off
Not long ago, I blogged about a plastic surgeon who aggressively pursues patients who refuse to pay her bills. The state is suing her to make her stop and also considering lifting her medical license. The central theme is that she makes patients who she sees in the ED to sign a form stating that they will pay her. It is unlikely that the patients are aware of …
Should we expect patients to think about costs?
Better Care for Individuals, Better Health for Populations, and Lower Per Capita Costs
–ihi.org
If you stop to think about the holy grail of health care reform, also known as the Triple Aim, it sounds like a grand challenge involving wizardry or wishful thinking or worse, propaganda for the masses, particularly the last part. It’s like attempting to build a better driving machine, with better fuel efficiency at lower cost. …
How pushing the Triple Aim ignores doctors and their patients
For years we’ve read that the US faces a looming shortage of nurses. Shortfalls in the hundreds of thousands of nurses are routinely predicted. These predictions have been good for nursing schools, which have used the promise of ample employment opportunities to more than double the number of nursing students over the last 10 years, according to CNN.
Yet somehow 43 percent of newly-licensed RNs can’t find jobs within …
The nursing shortage: Why it isn’t a good time to become a nurse
Trying to figure out what is going on with health care costs is like Alice’s adventures in Wonderland, things are just getting curiouser and curiouser. To illustrate: which of the following statements do you think are correct?
1. It’s been 50 years since health care costs increased this slowly.
2. The U.S. spends more on healthcare than any other country but our health is …
Do we really know what is going on with health care spending?
To treat observation care as simply a loophole that allows hospitals to avoid the Medicare penalties from readmissions — as Brad Wright, an assistant professor of health management and policy at the University of Iowa did earlier this month — is to take a short-sighted approach to a complex health issue.
Observation care in fact aims to address several of healthcare’s thorniest challenges head on. In the process, …
What is observation care? Clearing up common misperceptions
Adam Smith would disagree, Karl Marx would be appalled, and heck even Milton Friedman and Ayn Rand would be raising objections. But for some peculiar reason, there are enough contemporary lesser economic minds scattered throughout the entire philosophical spectrum, that are advocating for, and enabling the execution of, a government induced transition of our health care system to an oligopoly model …
Is consolidation the answer to healthcare’s fragmentation problem?
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“Pay for performance” made headlines again this week, when Health and Hospitals Corporation (HHC), the multi-billion dollar corporation which operates New York City’s public hospitals, announced that they will be linking physician reimbursement to pre-determined “quality” metrics and patient satisfaction scores.
This announcement comes quickly on the heels of details recently released by the Centers for Medicare and Medicaid Services (CMS) regarding its first Medicare payment adjustment to hospitals under the …
How will pay for performance ultimately impact the quality of care?
“He’s dead, Jim.”
So here’s my beef. At the recent Forbes Healthcare Summit there was a lot of focus on speakers and vendors offering very cool new tech, from future “Tricorders” that can diagnose multiple diseases, is non-invasive, and hand-held; personal genomics, where data from your own genome is cheap and easy to get and can be integrated with clinical knowledge to produce better care; targeted therapies for various diseases, …
Let’s solve our most pressing healthcare problems first
The September 2012 issue of the AARP Bulletin has a story about a woman who sued an elder-law attorney for legal malpractice. Bear with me. It’s an interesting tale.
In 2004, a man consulted an elder-law attorney to set up a trust that would distribute his assets fairly. He had a daughter from his previous marriage and his wife had five children from her previous marriage. The story is …
Are hospitals learning from the lawyers?
How many businesses do you know that want to cut their revenue in half? That’s why the healthcare system won’t change the healthcare system.
-Rick Scott, Governor of Florida
Former CEO, Hospital Corporation of America
The Washington Post recently reported that health plan lobbyists, charts at the ready, are working to convince legislators that unreasonable health care costs are everyone else’s fault. Karen Ignagni, the Executive Director of America’s Health Insurance Plans (AHIP) declared: “If you’re …
Health plans need to take more responsibility for rising costs
The ultimate cure to the perversions inherent in U.S. health system economics is cracking the risk code – optimizing the financial risk allocation for any given disease across payer, health system, physician and patient. After years of payer and more recently health system effort, the heat is increasing on doctors and patients.
Despite vigorous effort on wellness and prevention, it’s fair to say the industry has so far missed the mark …
Patients need pay for performance too
When someone is arguing that our health system needs an overhaul, one of the most common reasons they cite is because it is “built on a flawed foundation of fee for service.” Of course we blame fee-for-service reimbursement for the rampant overtesting, overtreating, and fragmentation (among other things) in our health system, but this doesn’t mean that it is inherently bad, and here’s why.
First, a little contextualization will help. Fee …
Is our system built upon a flawed foundation of fee for service?
We physicians like to think that we are really different from other workers. We physicians, perhaps thinking back to that medical school application essay we all wrote, really believe that we went into this career to simply help others. We physicians truly believe that we always put our patients first.
Because we sincerely believe all of the above, we are shocked when someone like Uwe Reinhardt points out that collectively we …
Are physicians really that special?
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