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When Money Isn’t Everything To Doctors

I recently pointed to a BMJ study concluding that pay for performance doesn’t seem to motivate doctors. It has been picking up steam in major media with TIME, for instance, saying: “Money isn’t everything, even to doctors.”

So much is riding on the concept of pay for performance, that it’s hard to fathom what other options there are should it fail. And there’s mounting evidence that it will.

Dr. Aaron Carroll, a pediatrician at the University of Indiana, and regular contributor to KevinMD.com, ponders the options. First he comments on why the performance incentives in the NHS failed:

Perhaps the doctors were already improving without the program. If that’s the case, though, then you don’t need economic incentives. It’s possible the incentives were too low. But I don’t think many will propose more than a 25 percent bonus. It’s also possible that the benchmarks which define success were too low and therefore didn’t improve outcomes. There’s no scientific reason to think that the recommendations weren’t appropriate, however. More likely, it’s what I’ve said before. Changing physician behavior is hard.

So if money can’t motivate doctors, what’s next? Physicians aren’t going to like what Dr. Carroll has to say. Read more »

*This blog post was originally published at KevinMD.com*

Medical Malpractice Reform: Would Doctors Accept The Deal?

The bipartisan debt commission appointed by President Obama recently released its recommendations on how to pare the country’s debt.

Of interest to doctors is the suggestion to change the way doctors are paid. Physician lobbies have been advocating for removal of the Sustainable Growth Rate (SGR) formula — the flawed method by which Medicare, and subsequently private insurers, pays doctors. According to this method, physicians are due for a pay cut of more than 20 percent next month.

According to the commission:

The plan proposes eliminating the SGR in 2015 and replacing it with a “modest reduction” for physicians and other providers. The plan doesn’t elaborate on what constitutes a “modest reduction” in Medicare reimbursement.

Meanwhile, the Centers for Medicare and Medicaid Services (CMS) should establish a new payment system — one that rewards doctors for quality, and includes accountable care organizations and bundling payments by episodes of care, the report said.

The commission also said in order to pay for the SGR reform, medical malpractice lawyers should be paid less, there should be a cap on noneconomic damages in medical malpractice cases, and that comprehensive tort reform should be adopted.

There’s little question that associating physician reimbursements with the number of tests and treatments ordered is a major driver of health costs. Removing that incentive, and better valuing the time doctors spend with patients, is a positive step in the right direction. Read more »

*This blog post was originally published at KevinMD.com*

Health “Care” Not Health “Performance”

The “empowered patient” movement (which I think is a good thing) strives to take the doctor out of the center of care and put the patient at its focus. The role of doctor is not to be the star of the show, the quarterback, the superhero, but the advocate and helper for the patient to accomplish their goal: Health.

Many rightly attack doctor prima donnas who want the exam/operating room to be about them instead of the patient. This is health care, not health performance. They want doctors who care more about the people they treat than they do about money, praise, or status.

I get it. I get the message that doctors have to adjust to this new age of patient empowerment and patient-centeredness. I get the fact that making patients wait is a bad thing, and that communication is as essential of a skill as is medical knowledge — remove either one of them and you don’t have care. I hear the message: Doctors should care about patients more than they care about themselves. That is what we are paid to do, and that is what we have neglected at our own peril. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Letting Doctors Care For Their Patients

“Ouch! That really hurts! You win, please stop torquing my arm behind my back. “Uncle! I said, Uncle!!”

Yes, the threshold has been reached. We docs no longer need a tennis court or a Mercedes, our kids are fine in public schools, and we will happily buy our own damn pens.

But, please, just give us some modicum of autonomy. Throw us a measly scrap and let us take care of our patients as we see best. Like Dr. Saul Greenfield so beautifully said today in the Wall Street Journal. The paragraph that stood out the most for me is as follows:

Physician autonomy is a major defense against those who comfortably sit in remote offices and make calculations based on concerns other than an individual patient’s welfare. Uniformity of practice is a nonsensical goal that fails to allow for differing expression of disease states.

Really, it isn’t hyperbole to surmise that the overwhelming majority of doctors would decide, if faced with a choice between less compensation and less autonomy, to choose less compensation.

As a teen my dad told me the best part of being a doctor would be the autonomy. He was right, and that’s what hurts the most these days.

JMM

*This blog post was originally published at Dr John M*

Medicine And The Gender Barrier

It’s only a matter of time before female physicians outnumber men, say medical school heads who are seeing more women in their programs. Although women have broken the gender barrier in medicine, they may want to keep going into nursing, because nurse practitioner salaries grew faster than primary care physicians’ pay – nearly 5 percent compared to nearly 3 percent.

Physicians can take some comfort that their average pay is more — $191,000 compared to more than $85,000 — unless they’re women, who among all the life sciences average $13,000 less than their male counterparts in comparable positions and with similar experience. (WCSC TV, Fierce Practice Management, Academic Medicine)

*This blog post was originally published at ACP Internist*

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