Paying doctors for better care
Should doctors be paid in accord with how often they treat you - or
how well they treat you? The answer presumably is a bit of both. Yet the
current fee-for-service reimbursement systems used by Medicare and other
insurance programs perversely reward doctors for the volume of services
they provide and pay little or no attention to the quality of those
services.
Indeed, a doctor who botches a surgical procedure, diagnostic test or
drug prescription and then has to follow up with corrective action
actually profits from his mistake. He gets paid for the botch-up and
then again for mitigating the mistake.
Thus it is salutary that the last Congress, in its waning days,
passed legislation that takes a modest step toward the goal of paying
doctors based on the quality of their treatment. It authorizes Medicare
to pay doctors a small bonus if they voluntarily report data on the
quality of their care, like whether they prescribe recommended
medications to heart attack victims or examine the feet of diabetic
patients.
If Congress decides to move the program forward, such data might in
time be used to reward doctors who practice the best medicine.
Even this first step had some critics accusing Congress of trying to
impose federally regulated "cookbook" medicine. But the notion of
pegging reimbursement to performance has strong support from leaders in
clinical and academic medicine, provided it is done carefully and in
collaboration with credible experts who know good medicine from bad when
they see it.
More than 100 pay-for-performance programs already exist, sponsored
by health plans, employer groups and Medicare.
Many take a graded approach: first paying doctors to report treatment
data, then paying extra if they follow professionally derived standards
of care, and finally paying more if they achieve successful outcomes -
measured, for example, by patient satisfaction or by keeping people
healthy enough to avoid hospitalization.
Patient advocacy groups like AARP and the Medicare Rights Center
favor the approach. Some medical societies, like those representing
anesthesiologists and thoracic surgeons, have been working on their own
quality standards. A 2004 poll found that a large majority of practicing
physicians supported payments based on quality of care.
There is a clear need to improve the quality of care in a medical
system that - despite excellence at the very highest levels - permits an
alarmingly high rate of medical errors that harm tens of thousands of
patients and drive up costs substantially. We can only hope that this is
a real reform in the making, not a passing fad in the endless struggle
to improve the health care system. Guardian |