NYT: Pay doctors by salary rather than procedure

Sending Back the Doctor’s Bill

The way that doctors are paid may be an even more significant factor driving up [medical] costs and may lead to unnecessary care, said Dr. Peter B. Bach, a pulmonary physician at Memorial Sloan-Kettering Cancer Center and a former senior adviser to Medicare and Medicaid.

In the United States, nearly all doctors are paid piecemeal, for each test or procedure they perform, rather than a flat salary. As a result, physicians have financial incentives to perform procedures that further drive up overall health care spending.

Doctors are paid little for routine examinations and very little for “cognitive services,” such as researching different treatment options or offering advice to help patients get better without treatment.

“I don’t have a view on whether doctors take home too much money or not enough money,” Dr. Bach said. “The problem is the way they earn their money. They have to do stuff. They have to do procedures.”

[Fern]

Thanks for sharing this article. I read the NYT regularly, but somehow missed this one.

Me. and my boyfriend doctor are leaving for a trip tomorrow and since it's a long road trip, i thought i would bring some selected things to read aloud to him while he's driving, to help pass the time.

This will be one of them!

[InDebtInDC]

This issue has been a long time problem with capitation. Since patients get an all-you-can-eat buffet when they seek care, the physician's incentive is to provide less than optimal care to increase profits.

They just want to keep the patient healthy enough so that the patient doesn't incur high cost procedures. Otherwise, physicians have no financial incentive to provide the highest quality of care for fixed-fees.

Health plans have tried to address this issue by offering incentives for physicians to cut cost and increase quality of care, but there are legal issues with this. As of right now, gainsharing and kickbacks are illegal for physicians. Read up on this topic if you're interested. Just search Google for these words. There are literally thousands of article about the subject.

There is really no easy answer to solve these problems.

They just want to keep the patient healthy enough so that the patient doesn't incur high cost procedures. Otherwise, physicians have no financial incentive to provide the highest quality of care for fixed-fees.

Most physicians aren't physicians just for the money. I dispute the idea that they're just keeping the patient "healthy enough". And if there is a physician that does this, over the long run he'll lose all his patients and will hopefully get fired.

I agree there are no easy answers here, but something must be done. My health care costs are sky high and supposedly I'm one of the lucky ones with fairly good insurance.