Fee-for-service medical programs have been the norm in the United States for several years. A patient comes in with a troubling medical ailment and a physician diagnoses and prescribes an appropriate treatment. At the end of the day, the doctor gets paid based on the services he or she provided the patient, regardless of the medical outcome the patient faces in the future from these services. Not much incentive is created for the doctor to do everything he or she possibly can to follow up on their patient and ensure their medical well-being, as their pay-check is unaffected either way.
Therefore it only makes logical and ethical sense that a doctor who has a history of better medical performance is paid higher than one who does not. If a doctor’s salary is dependent upon how well they treat their patients and how successful their medical outcomes are, then they will have an incentive to put more time and care into their individual patients, something I believe that all those seeking help from a medical professional deserve. This idea of “incentivizing quality”, or incentive pay, can increase the have many great benefits to the treatment of patients around the country. Dr. Pauline W. Chen believes that when patients are treated individually, the “risk of their treatment must be outweighed by the benefits”, something that may not have been as equally important or considered by a physician who was working in a fee-for-service medical program.
Some might argue that it is difficult to decipher how much a patient’s medical outcome is influenced solely by the efforts of his or her physician, making incentive pay an inaccurate means of compensating physicians. However, the increasing use of statistical models has been aiding tremendously in the evaluation of doctors by taking into consideration factors that may be out of the control of physicians, such as underinsurance. “Pay-for-performance can work” says Dr. Clemens S. Hong, an internist at the Massachusetts General Hospital, “but we need more sophisticated measures to make sure we are actually measuring physicians quality”. With new and more accurate methods of evaluating physician quality developing each day, we are headed closer towards distinguishing doctors that put more effort into their patient care from those who put in less, and these findings will result in each doctor being rewarded accordingly.
As a patient, I want to make sure that my physician is putting as much effort into the quality of care I receive as possible, by any means necessary. Whether or not it seems ethical that a physician is motivated to care for his or her patient by monetary gain is irrelevant, the fact of the matter is, the patient receives better quality care than if these incentives were not in place.
Sources:
http://www.nytimes.com/2010/10/01/health/01chen.html?_r=2
http://ifawebnews.com/2010/04/30/ibc-to-pay-doctors-for-quality-using-new-pay-for-performance-model/
http://www.allbusiness.com/insurance/health-insurance-government-health-medicare/12305470-1.html
1 comment:
Perhaps pay-for-performance should be implemented so that doctors have a deeper (or perhaps, more shallow?) incentive for meticulous patient care. As Dr. Hong mentions, human nature is “to go to where the incentives are.” Based on the fundamental economic concept of rational self-interest, doctors should be paid on merit and for their accomplishments.
Though the crux behind this new system has potential, this argument is flimsy for a few reasons. As you mentioned, not all patients are influenced equally, and improvement evaluation is not easy: the article in JAMA showed that in poor neighborhoods with a high minority ratio, improvement would be magnified. These aspects of the program obviously need to be fixed.
But I feel there’s more to the story than even just that. From an ethical standpoint, these practitioners that medical schools have hand-picked for their qualities and commitment make an effort from the get-go “as to preserve the finest traditions” (Hippocratic Oath) of their vocation. As you mentioned, “I want to make sure that my physician is putting as much effort into the quality of care I receive as possible.” Even without the incentive of a bonus, I should hope my doctor is doing the best he can since I’m paying for the clinical visit anyway.
And does that mean doctors who aren’t as influenced by the prospect of monetary benefits are less inclined to do a good job? To put things in perspective, when I go to a restaurant, my waiter might be a doting old man or a groggy, dejected college student. Both know that better performance could land them a tip, but they act differently anyway- because everyone has their priorities. It would be no different here.
Lastly, by subjecting the doctor-patient relationship to financial gains like the extra salary you can "make off a patient" could be just as harmful. Some doctors could keep patients for longer if this were the new standard, even if these patients can heal on their own.
In short, I see the medical profession as one of empathy, compassion, and diligence regardless of what may be going on in the doctor’s personal life. What stimulates an entrepreneur shouldn’t be what stimulates a doctor. As Mary Roberts, CEO of a brass lighting fixtures company, said about pay-for-performance programs, “I don’t think people are motivated by rewards and bonuses. I think they’re excited about their jobs or because they’re doing something that provides a service to the world.”
Shockingly enough, Ms. Roberts didn’t even have to take the Hippocratic Oath to come upon that nugget of truth.
http://www.zigonperf.com/resources/pmnews/proscons.html
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