The Obama administration wants to dramatically change how doctors are paid
Source: Washington Post
The Obama administration on Monday announced an ambitious goal to overhaul the way doctors are paid, tying their fees more closely to the quality of care rather than the quantity.
Rather than pay more money to Medicare doctors simply for every procedure they perform, the government will also evaluate whether patients are healthier, among other measures. The goal is for half of all Medicare payments to be handled this way by 2018.
Mondays announcement marks the administrations biggest effort yet to shape how doctors are compensated across the health-care system. As the country's largest payer of health-care services, Medicare influences medical care generally, meaning the changes being initiated by the administration will likely be felt in doctor's offices and hospitals across the country.
As a very large payer in the system, we believe we have a responsibility to lead," said Health and Human Services Secretary Sylvia Mathews Burwell in a press conference. "For the first time, were going to set clear goals and establish a clear timeline for moving from volume to value in the Medicare system.
Read more: http://www.washingtonpost.com/blogs/wonkblog/wp/2015/01/26/the-obama-administration-wants-to-dramatically-change-how-doctors-are-paid/
Erich Bloodaxe BSN
(14,733 posts)I tend to think doctors are overpaid in general, and that current fee per service models overincentivizes unnecessary tests and procedures, but on the other hand, this strikes me as being similar to basing teacher pay on student performance, without taking into account the large number of factors that go into student performance that are beyond the control of teachers, and ditto health. I'm all for government wanting a healthier population, but I think the place to start is to stop subsidizing the use of corn and sugar throughout the food chain, fossil fuel extraction in the environment, and really ramp up the testing of the vast number of chemicals in common use in modern America for which little or no testing data exists.
teenagebambam
(1,592 posts)Monumentally bad ideas seem to be America's stock in trade lately.
still_one
(92,250 posts)the conventional sense, in fact in many cases just being stable or pain free could be considered a success. Sometimes people get worse because of no fault of the doctor, but the nature of the condition being treated.
Most important many successful treatments are dependent on the patient compliance. In addition, people do not always react the same way to treatment. This is do to different physiology etc.
As someone said this is a lot like judging teachers on test scores.
Perhaps before we change something like that we should try it on Congress first, and pay them on the basis of what they accomplish.
I figure we could save hundreds of thousands of dollars based on the record of Congress
CTyankee
(63,912 posts)It's really a good idea and one that other advanced countries are already doing. Or at least that is my understanding. I think folks are overreacting and being a bit simplistic.
still_one
(92,250 posts)840high
(17,196 posts)they're paid is ok with me. Not only education but setting up an office is expensive.
Erich Bloodaxe BSN
(14,733 posts)I've actually got more than 16 years of college behind me, along with 6 college degrees.
And it doesn't have me rolling in the money.
840high
(17,196 posts)you save lives?
elehhhhna
(32,076 posts)Response to elehhhhna (Reply #36)
840high This message was self-deleted by its author.
Erich Bloodaxe BSN
(14,733 posts)Recursion
(56,582 posts)JDPriestly
(57,936 posts)of repaying the debt for all those years of study means not having a marriage or a family for some. It's really tough.
I am very dubious about this. What if someone has a chronic condition like eczema for which there really is no "cure," not even really much that helps get it under control, just years of misery? Is the doctor to be penalized because the patient needs frequent checks and help but isn't going to ever get well?
That is just one example of a problem that may take a lot of doctor's visits and really won't get better over time.
And what about the illnesses of a very elderly person. The hip operations, the knee operations, then the pneumonia and infections that just are a part of the final years of life -- the heart problems -- the high blood pressure. Hey! We are born to die in time. We want to encourage doctors to treat the very elderly patients who are living their last years well. If the doctor gets less because the outcomes are not good and because the patient returns to the hospital over and over and has declining health, it just does not seem right.
Efficiency is not everything. This system will discourage the kind of compassion that a patient, especially a very uncomfortable patient or a patient in the final stages of life needs and deserves.
This is another case of some MBAs applying their useless, inhuman mathematical analysis to a human problem. Totally the wrong way to deal with doctors' pay.
candelista
(1,986 posts)If you mean 20 years, then should Ph.D.s get paid whatever they want? Great idea, but I doubt you mean it.
Sunlei
(22,651 posts)he saw. 3k was the average of every 10 regular appointments.
Even regular Vets have their "30k days" more then once or twice each year.
VanillaRhapsody
(21,115 posts)can't have Obama doing something else great after you have denigrated him so badly!
By the way....,Obamacares is coming in 20% cheaper than anticipated.....according to the CBO...
right????
freshwest
(53,661 posts)VanillaRhapsody
(21,115 posts)JDPriestly
(57,936 posts)VanillaRhapsody
(21,115 posts)BrotherIvan
(9,126 posts)I think doctors should not be evaluated on how the patient fares because he or she does not control all the factors. It assumes the doctor is solely responsible for making the patient eat right, exercise, or genetic factors. Do I think doctors spend endless money on test to cover their asses because they often they can't even begin to make a proper diagnosis because clinical observation is no longer trusted? Yes.
Do I think it would be better to encourage companies to provide exercise areas and breaks, healthy eating options for lunch like Michelle Obama is doing for schools? I think that people are suffering tremendously from stress and lack of sleep and that directly affects their health. As well as financial difficulties and the inability to find or buy healthy food.
There is a whole host of factors that can be improved, including as you mention, the terrible things that processed and fast food companies can dump in their non-food that is not allowed in most other countries. I am rather skeptical about this proposal.
VanillaRhapsody
(21,115 posts)BrotherIvan
(9,126 posts)snappyturtle
(14,656 posts)BrotherIvan
(9,126 posts)Hm, I wonder what LLI really stands for?
"The voices in my head"
"Source of all my bitter rage"
"Long Lost Idiot"
"Lefty Loves Insult"
"Lambasted Lobotomy It"
"I only react with spite"
It's a mystery!
Faryn Balyncd
(5,125 posts)Measuring value accurately, efficiently and cheaply may be easier said than done.
Another factor that deserves consideration are the possible unintended consequences regarding incentivization if compensation is tied to outcomes.
The incentives to treat patients with multiple medical issues and with uncertain or poor prognoses will change in ways that may not necessarily be in line with our ideals of humane care.
It also sounds like such a system would also continue to increase the amount of resources devoted to attempting to document that a patient has documented issues which result in higher compensation. (That assumes that outcome measurement adequately and accurately takes consideration of sicker patients generally worse prognosis, and increases compensation accordingly, which will be difficult to measure. If this is not the case, (and compensation not adequately increased for such patients, then the clear incentive would be for providers to avoid sick patients, and those with poor social support systems or other factors that worsen their prognosis, like the plaque.
I agree with you that the place to start would be changing incentives so that cognitive skills are more highly paid, with less incentivization of resource-intense tests and procedures. Doing this would improve quality while lowering costs, and would avoid the possibility of perversely altering incentives as above.
Thinkingabout
(30,058 posts)High numbers for bladder cancer, he had already been in a nursing home and from other complications had to be hospitalized. His hospital doctors wanted to do a biopsy"to determine if he really had bladder cancer" which meant putting him to sleep and this isn't good for Alzheimers patients. My mom and sister refused and the doctors insisted, my mom ask what they planned to do if he had bladder cancer and was told nothing. Well, my mom held strong and did not think she wanted him to have the biopsy. This was wrong to subject a patient to these tests.
840high
(17,196 posts)to say "no. As she did. After my breast cancer my oncologist insisted on chemo. I said "no."
madamesilverspurs
(15,806 posts)Imagine a scenario in which a doctor notifies an insurance company that his patient requires a surgery that will take 11 hours and cost $100k, but he says that he will take $30k to tell the patient that bed rest will fix the problem. The company takes his offer, the doctor gets paid for doing nothing, and the patient goes home unhelped; the company saves money, the doctor makes more phone calls, the patient suffers.
That did happen, and the medical community worked quietly to move the physician into 'early retirement'; don't know how the various insurance entities were dealt with. Those patients would have preferred to have the scheme blown all over the media and the conspirators put in prison, but it didn't turn out that way.
So I'm thinking that "why" a doctor is paid should factor into "how" he is paid.
jeff47
(26,549 posts)Saving that $70k isn't turned into profit. Makes the incentives a tad different.
Frustratedlady
(16,254 posts)By the time Medicare reduces the fee, the doctor doesn't get a great deal as is.
I would imagine a higher number of doctors will refuse Medicare patients. I could be wrong. My doctors rarely spend more than 15 minutes with me unless there is really something serious, then they spend whatever time they need to do a good job. I hope this change doesn't change that situation.
SummerSnow
(12,608 posts)a few years back one of my doctors use to prescribe me Robitussin for everything and anything that ailed me. I had a cyst and he prescribed me Robitussin. I kid you not.
840high
(17,196 posts)SummerSnow
(12,608 posts)I made it a priority with the insurance co due to my daughters health . it would have taken 2 weeks under normal circumstances.
freshwest
(53,661 posts)Guess he thought Robotussin was a good way to quiet you...
And he sounds like a Quack!
shanti
(21,675 posts)My Good Babushka
(2,710 posts)Insurance companies already cherry-pick the healthiest patients, and I don't see what will stop doctors from doing the same thing.
jeff47
(26,549 posts)Unless you want to privatize Medicare.
LiberalArkie
(15,719 posts)involved besides medicare, and I have Aetna for part D (Prescriptions) that has listed my asthma medication and some others in their book along with the pharmacies in my county. I went to get them filled and Aetna called me before I got out of the building telling me that the pharmacy is no longer in the "network" and the meds are no longer covered. I told them they were in the book. They told me that they change what they cover all the time and the book is just a guide line. I can't change my coverage until the end of the year to someone who covers my drugs, so it is out of my pocket until January.
What fun..
jeff47
(26,549 posts)Supplemental policies such as yours would be negotiated separately between the insurance and the doctor.
My Good Babushka
(2,710 posts)but doctors may start 'recommending' other doctors to very sick patients.
Demeter
(85,373 posts)You can't be too cynical, at least, I can't.
HeiressofBickworth
(2,682 posts)Doctors cherry-pick patients in order to keep up their score of "healthy" outcomes -- after all, many physicians aren't taking Medicare patients even NOW. The only reason MY general practitioner kept me after I went on Medicare was that I was already a long-term patient. She said she takes no new Medicare patients.
Medicare patients have no other medical care available and become sicker quicker.
The Alan Greyson theory becomes fact -- get sick, die quick.
Medicare saves money, physicians make as much money as they can under the system, and the rich still get as much health care as they want or need, the sick and disabled die sooner and get out of the way. The over arching benefit is to reduce the total population and ensure that the surviving population is healthy enough to work. No useless eaters left.
Hasn't this "master race" thing been done before????
CountAllVotes
(20,876 posts)I agree! Medicare doctors are becoming fewer and fewer and ones that do accept Medicare are taking no more patients and have closed their practices to them. This is not good!
And where are all of those "Medicare for All" cries now? I hear none.
area51
(11,912 posts)But I believe all of us in favor of it know that it needs to be improved to cover a hell of a lot more, and that payments to medical professionals have to be raised.
CountAllVotes
(20,876 posts)Some people that are disabled are on Medicare.
I have PPMS (primary progressive MS). There is nothing that can be done for me. I know this and my doctor knows this.
What are they going to do in a case like this (and I am sure there are many others out there that are on Medicare, totally disabled with a poor/negative prognosis)?
Just go home and die is what I pick-up, and the sooner the better.
mikemcl350
(10 posts)merit pay.. if its good for teachers its good for doctors too!
Hoyt
(54,770 posts)and helping patients with diabetes, heart disease, etc. The systems have been around for years. Docs have been against it because they can't profit off ordering tests on equipment they own, or results they interpret.
Recursion
(56,582 posts)Mojorabbit
(16,020 posts)zipplewrath
(16,646 posts)I understand your concern, but if this is anything like similar programs that have been tried, it's not really how it works. Typically each procedure or test or whatever has "effective outcomes". i.e. if a test identifies an intended condition, or a procedure results in "cure". Often these things are measured as much by the number of follow up appointments/procedures. In extreme cases, it gets measured in subsequent hospitals stays/days. The doctor "risks" as much by not doing an appointment as he does doing one.
The danger I see is that patients won't be able to get certain tests or procedures because no doctor will take the "risk". It puts them firmly in control. Right now most doctors will allow you to choose any "reasonable" request, as long as the insurance will cover it. In a new system they may be more resistant. This may or may not be for the better.
Igel
(35,320 posts)"my brother's warden."
(That's how I interpret "keeper."
That's already happened in many school districts: If a student fails, it doesn't matter--it means the teacher has failed. Teachers are their student's wardens, their custodians. If a student screws up, accountability falls on the teacher. At least it used to be the parent that was responsible for a kid's screw ups. After all, they have the authority to do something about it.
So now they want a doctor to be responsible for forcing his (her) patients to live healthier lives, stick to their prescriptions, seek follow-up care, and follow doctor's recommendations and orders? And, of course, if they manage to compel doctors to do that, politicians will take the credit. It's all about taking credit for what you force other people to do or what you do with their money.
I know: How about we first do that with lawyers and politicians. Lawyers are held responsible for what their clients do. A lawyer gets a client off who goes and kills somebody, it's that lawyer's responsibility. A politician passes a law that doesn't work out, the politician is held completely responsible for it and can be personally sued in a class action suit. A politician's appointee screw's up, it's really that politician's failure and his (her) personal or election finances have to make the electorate whole.
nolabels
(13,133 posts)Our society hasn't failed, it's the politicians owned by the billionaires that is starting to fail.
Having fun with social media that goes around the status quo electronically really must erk a few of those well heeled folks
Ka hrnt
(308 posts)This is the same economist-thinking garbage Arne Duncan has saddled education with--measurement, measurement, measurement. As another posted stated, this is doomed to fail (or produce unintended side-effects) because they're going to judge doctors on outcomes that don't directly control. Same with education, this administration thinks teachers are the main factor in test scores when the research (and common sense) shows they aren't.
BrotherIvan
(9,126 posts)This is Race to the Top in an even dumber way. I can't believe people are defending this. Doctors will do what they do now: stop taking Medicare patients.
Recursion
(56,582 posts)because they're going to judge doctors on outcomes that don't directly control
Fine. But then that faces the same problem the argument against outcome-based assessment in education does: if you can't actually say person A will reliably have better outcomes than person B, why does it matter who's a doctor/teacher? Just grab somebody to do both for minimum wage, since by your argument it doesn't matter who does it.
jwirr
(39,215 posts)Hopefully I am wrong. But "results tests" are not so great for everyone. Take my disabled daughter. She is NOT going to get much better ever. She has had partially uncontrolled seizures, digestive problems and mental retardation since she was born. It was a miracle that she lived and she has lived 30+ years beyond her original life expectancy but she is now showing her age. We have already found all our miracles for her so how are they going to rate her health care. What we are doing now is maintaining.
I suspect that there are a lot of people who are as good as they are going to get. There will be no more results.
pnwmom
(108,980 posts)just like there is little motivation for teachers to work with the most challenging students.
Hoyt
(54,770 posts)jwirr
(39,215 posts)just helping her to maintain her life as it is.
pnwmom
(108,980 posts)Hoyt
(54,770 posts)There are ways to adjust payments for a patient's baseline condition. It's really not difficult, just different. Scares some folks.
pnwmom
(108,980 posts)be getting better, but will need constant medical care. I don't see a simple solution that will encourage doctors to want to care for these people.
Hoyt
(54,770 posts)pnwmom
(108,980 posts)who has several complicating issues that will make his record look less successful.
Just as some hospitals can look worse statistically because they treat the most sick or injured patients.
Hoyt
(54,770 posts)pnwmom
(108,980 posts)So we shall see which "systems" they decide to use and how successful they are.
Based on its experience rewarding schools for "excellence," I'm skeptical.
Hoyt
(54,770 posts)healthcare outcomes, at the highest cost, among advanced nations. Our reimbursement system is primarily responsible.
I applaud Obama for trying to change that and overhaul our healthcare system. Unfortunately, even those who have been griping that the ACA is not healthcare reform, can't acknowledge what this proposal will do to improve delivery and outcomes. Obama can't win.
pnwmom
(108,980 posts)But I am skeptical about this particular proposal.
If we're going to change things, I'd rather doctors were paid in salaries, rather than piecemeal.
Hoyt
(54,770 posts)JDPriestly
(57,936 posts)Frankly, I think we should have universal healthcare and pay doctors salaries based on their patient caseload. They could be paid a part of their income based on the procedure. The outcome of treatment depends too much on the cooperation of the patient. It would not be fair to pay doctors less because a patient does not comply with instructions or take prescriptions.
JDPriestly
(57,936 posts)The system sounds like something some MBA dreamed up just to try to fool people into thinking he is useful.
Sounds just awful. Some conditions are chronic. Some patients do well. Some don't. The doctor's care is often not the decisive factor.
The idea is ridiculous and unfair. Doctors and hospitals will cherry-pick and will find ways to game the system.
Just pay doctors for their work. Pay teachers for their work. Give doctors and teachers continuing education and tools to improve their work.
Changing the way you pay them is a superficial and distracting way to attack the problems that doctors face. It's counter-productive.
I do not like this idea at all.
Hoyt
(54,770 posts)make the AMA and doctors, happy and rich by ordering more MRIs than necessary and continuing a largely uncoordinated system of healthcare delivery.
pnwmom
(108,980 posts)including young disabled people and the very elderly.
Thank you for trying to educate. And good luck and warm wishes for you and your daughter.
cadaverdog
(228 posts)my wife and I have had coverage through Kaiser-Permanente for over forty years. Now that we are both retired we are in Kaiser's Senior Advantage program, along with Medicare, and so far it's all smooth sailing, now that we have gotten through the reams of paperwork you need to fill out when you retire (hint: make copies of everything).
To those of you who are contemplating changing your coverage in the future, I hope you will take a hard look at what Kaiser has to offer, if indeed they are available in your locale.
Sorry to sound like a commercial, and good health to all.
Hoyt
(54,770 posts)Skittles
(153,169 posts)you mean exactly what, copies of the paperwork you're filling out?
cadaverdog
(228 posts)along with forms for Social Security and Medicare Part B, attesting to your eligibility for benefits, as well as your company and/or union retirement funds. If you are married and your wife is also near retirement, then everything is times two. If you are still working, check with your employer ahead of your retirement date for information, as well as a Social Security office. If you currently have health insurance you want to contact your plan for information on the Senior Advantage program, and how it works in conjunction with Medicare Part B.
You will be filling out a lot of forms along the way, and I strongly urge you to make copies of everything, since almost certainly something will get lost in the process. The good news is it's all worth the trouble in the end.
Good luck!
BadgerKid
(4,553 posts)Punish the doctors because patients don't follow directions? Because a patient has a genetic anomaly that renders a drug ineffective? Tread carefully, sirs.
blkmusclmachine
(16,149 posts)Nay
(12,051 posts)face the fact that our 'health care' system is a bloated, expensive mess that simply shovels money to insurance companies and other private entities. Its prime motivation is to hoover up money, not tend to the health of the citizens.
Blackjackdavey
(178 posts)It is the industry standard. The administration is merely keeping pace with the industry standard as clinics and hospitals are WELL UNDER WAY toward transitioning to an outcomes based reimbursement scheme. This is the way all healthcare reimbursement will be done in the next two years. If you don't think it's a good idea perhaps you could thank the administration for bringing it to your attention because if you have private insurance, they are already well on their way toward doing it this way and likely will be before medicare even gets started.
McCamy Taylor
(19,240 posts)to find providers, because no provider will want to be penalized for not miraculously curing their incurable conditions and turning them into "well" patients. Urban minority seniors will be especially hard hit as hospitals relocate to wealthier and healthier communities. Boutique hospitals that cater to rich, healthy seniors will be rewarded.
Herself
(185 posts)and treating conditions..
They will protect their "report card" at any costs, including your health, and life if need be.
Patients are taking the brunt of the fight between insurance, doctors, hospitals and govt
Blackjackdavey
(178 posts)As someone in the healthcare industry, in upstate New York, I just wanted to jump in and point out that this proposal is hardly groundbreaking or unique to medicare. I have attended numerous seminars over the past year, and more to come, on this issue alone as it will become the industry standard over the next two years. All insurance reimbursement will be tied to outcomes. The benchmarks are generally simple and for the examples given above it will generally be something like measuring avoidable return visits for the same problem within a limited timeframe -- so doctors won't be penalized for routine treatment of chronic conditions. This follows the same model that is being implemented for hospital care in general.
FLPanhandle
(7,107 posts)Maybe if drug prices where tied to how they improved patients lives, then that I could get onboard with.
cynzke
(1,254 posts)A curse. Compensation should be based on the quality of service, but not at the expense of quantity. A doctor should not have to sacrifice one for the other. Medicare should encourage both. As long as the quality is good, the doctor should not be restricted on the quantity of service provided. Most doctors feel they are not compensated enough as it is, this could make it worse if there are not enough incentives provided. The major complaint seems to be that there are not enough doctors that accept Medicare in the first place. The compensation should be tiered in a way that increasingly rewards the doctors who provide quality care, without sacrificing the overall pool of doctors available to Medicare patients, which is already smaller than necessary. Better compensation will bring better doctors, expand the pool, and then start weeding out the doctors who are milking the system by quantity and shortcutting the quality. I think both could be accomplished, depending on the quality with which Medicare formulates a plan. This is where it could be a blessing or a curse.
Sunlei
(22,651 posts)Some Doctors have set-up 'volume businesses' where they can grab much more in Gov. medicare/medicade federal money.
mopinko
(70,138 posts)broad data on outcomes of various procedures can only add to our knowledge. grifters will be easily spotted. i think that would be the main point.
the aca's provision to ding hospitals w high readmission rates is an example of how this sort of data can benefit patients.
i could be worried about this, but i have no doubt that push back from docs, and compromise that will follow, will keep this fair.
as it stands, data in the medicare system is impervious to analysis. that is a waste of human life and money.
Aristus
(66,399 posts)I think getting rid of fee-for-service is a good idea. Driving down the exorbitant costs of medical care will require a number of changes to the way we practice and pay for medical care, to say nothing of the way we train and educate clinical practitioners. And eliminating fee-for-service should be one of them.
The health service organization I work for pays its medical providers a salary. I earn just as much on a slow day (like today, come to think of it) as I do on a day when I have to visit with 26 patients. Focusing on clinical outcomes is my primary concern, not how much I'm getting paid for every lab test I order.
More and more independent practitioners are selling out to major hospital groups and taking positions as salaried providers. And I think that's good. Let someone else worry about how the square-footage and the electricity is going to be paid for, and have the provider concentrate on providing good medicine with positive clinical outcomes.
Mojorabbit
(16,020 posts)He never based care on how much he would be reimbursed. It is the docs we knew who sold their practices to the big hospital corporations here that complained how they were leaned on to see more patients spending less time to bring in the bucks. They were without exception sorry they had given up their autonomy and ability to give the kind of care they were used to giving. Perhaps it is a different experience depending on location.
Aristus
(66,399 posts)one panacea solution to the problem. And corporations piling unacceptable numbers of patient visits for providers is another form of the problem of expensive and ineffective medical care. For for-profit corporations, revenue expectations go beyond overhead into the realm of gross profit; as much of it as their investors demand. And that's bad for everybody except the investors; unless of course they seek the same level of medical care as they expect their overworked providers to offer.
RobinA
(9,894 posts)that not only will Medicare get to tell doctors how to practice (which they already do) but also tell them the patient has to get better doing it that way or else. Sounds like a recipe to make medicine even more manualized than it is already. Which is good, I guess, because who the hell is going to put the time, effort and money into medical school for the privilege of becoming a Medicare/insurance company flunky.
Hoyt
(54,770 posts)Mojorabbit
(16,020 posts)Gosh, the practice of medicine is as much art as science. No two people are alike and it takes skill to find the best treatment for that particular person. One size does not fit all. I am not against standards but there has to be room to treat people as individuals.
Hoyt
(54,770 posts)really know what they are doing, especially with serious diseases. Marcus Welby really doesn't exist anymore.
Since you asked: I'm not a clinician, but I have plenty of experience -- government health/welfare agencies, working for medical associations (doctors' unions that protect their kingdom, at all costs), university research organizations. etc.
Fact is, the USA gets less for our healthcare expenditures than any advanced country in terms of outcomes and cost. If we don't change the current model that encourages doctors to practice in an uncoordinated, inefficient vacuum; order as many tests as possible; etc., none of us will have decent healthcare down the road, even if we increase taxes and reduce the military budget to zero.
Mojorabbit
(16,020 posts)My husband could have been Dr Welby. He saw people for free, he made house calls, paid for meds and diagnostic tests for patients who could not afford it,..he cared about all his people. Almost all the family practice docs I know are prettu much like that so I have a different view. I do know many specialists that fit your description though.
Hoyt
(54,770 posts)RobinA
(9,894 posts)Hoyt
(54,770 posts)would be better handled by specialists. More importantly, they don't do a very good job of coordinating care.
Here's an example of what folks who specialize in "sick" patients can do to improve/maintain their health status: A 58-year-old with diabetes, heart disease and Parkinsons, relies on an special case manager to call him every month to check on how hes doing and help him get the right care from his array of specialists. According to the patient, shes been very instrumental in pointing him in the right direction and sees her as a kind of glue because she saw him as a whole patient.
You can laugh all you want, but our current system needs to focus on outcomes, not the volume of junk performed under a reimbursement system that rewards volume, not outcomes.
CTyankee
(63,912 posts)I'm not seeing anything that makes me think this proposal will not be nuanced and treat patients as individuals...
Mojorabbit
(16,020 posts)I can't count the number of times my husband used to have to wrangle with insurance companies so that he could prescribe a med for a condition. I remember him hollering to one on the phone, "what med DO you cover for this condition". I know I have to jump through hoops to get the medication I take for MS as the insurance company wants me to be on something cheaper that does not work for me. I do not foresee any nuance as formularies are tightened down and people are pigeonholed into predetermined algorithms for particular conditions. I could be wrong but I don't think I am. Time will tell.
CTyankee
(63,912 posts)We cannot underestimate that essential fact. It is why every other advanced nation has universal health care for its citizens and treats it as a right. And it is why those systems, esp. ones in Western Europe, have better outcomes and lower costs. Every citizen is served. It is why none of the citizens of those nations want our for profit health care system, preferring the higher taxes they pay in exchange for an equitable and fairer way to provide health care.
fxstc
(41 posts)The end result will be doctors only taking on healthy patients, and in the end the really sick will get screwed even more.
Seriously the government needs to focus on things they are already tasked with and quit trying to fix everything and ending
up ruining everything.