Pres Obama raised some eyebrows when he implied in his press conference that doctors will sometimes opt to perform surgery on patients because the reimbursements are higher. The example was silly since surgeons – not GPs – generally rip out tonsils.
But, there is a broader issue: how & why might a doctor perform unnecessary or marginally required procedures.
Here are a couple of interesting factoids.
Excerpted from WSJ: Obama and the Practice of Medicine, Aug 14, 2009
Medicare data shows that for the most part, major surgeries aren’t the source of waste in health care. These kinds of procedures are typically guided by clear clinical criteria and are closely scrutinized by doctors and patients alike. Rather it is in routine procedures and treatments that economic incentives factor heavily into doctors’ decisions.
But, doctors have been accused of excessive prescription of home medical equipment and excessive utilization of radiology scans since — In the absence of financial incentives to restrain excess use — relatively safe diagnostic procedures can often be justified—even if their benefits are slim.
For doctors whom Medicare pays per intervention, the problem isn’t the fee-for-service model, but the way that the government program sets the fees. Medicare’s size demands that it keep payment systems simple. Thus it relies on fixed prices for checklists of services tied to discrete billing codes. These uniform payment rules reward low and high quality care the same. Fees are set according to a fixed price schedule with no tie to the physician’s quality, experience level, or the outcome of the service.A more rational system would pay doctors for entire “episodes of care,” rather than individual procedures.
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Full article:
http://online.wsj.com/article/SB10001424052970204409904574350370729883030.html
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The Homa Files 