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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*

Concierge Medicine: The Cost Of Healthcare “Room Service” And Other Hospital Amenities

A per­spec­tive in [a recent] NEJM con­sid­ers the Emerg­ing Impor­tance of Patient Ameni­ties in Patient Care. The trend is that more hos­pi­tals lure patients with hotel-like ameni­ties: Room ser­vice, mag­nif­i­cent views, mas­sage ther­apy, fam­ily rooms and more. These ser­vices sound great, and by some mea­sures can serve an institution’s bot­tom line more effec­tively than spend­ing funds on top-notch spe­cial­ists or state-of-the-art equipment.

Think­ing back on the last time I vis­ited some­one at Sloan Kettering’s inpa­tient unit, and I mean­dered into the bright lounge on the 15th floor, stocked with books, games, videos and other signs of life, I thought how good it is for patients and their fam­i­lies to have a non-clinical area like this. The “extra” facil­ity is privately-funded, although it does take up a rel­a­tively small bit of valu­able New York City hos­pi­tal space (what might oth­er­wise be a research lab or a group of nice offices for physi­cians or, dare I say, social work­ers) seems wonderful.

If real healthcare isn’t an even-sum expense prob­lem, I see no issue with this kind of hos­pi­tal accou­trement. As for room ser­vice and order­ing oat­meal for break­fast instead of insti­tu­tional pan­cakes with a side of thaw­ing orange “juice,” chicken salad sand­wiches, fresh sal­ads or broiled salmon instead of receiv­ing glop on a tray, that’s poten­tially less waste­ful and, depend­ing on what you choose, health­ier. As for yoga and med­i­ta­tion ses­sions, there’s rarely harm and, maybe occa­sion­ally, good (i.e. value).

But what if those resources draw funds away from nec­es­sary med­i­cines, bet­ter soft­ware for safer CT scans and phar­ma­cies, and hir­ing more doc­tors, nurses or aides? (I’ve never been in a hos­pi­tal where the nurses weren’t short-staffed.) Read more »

*This blog post was originally published at Medical Lessons*

Medical Marketing: More Money Wasted

There was a series of ads on the radio awhile back that went something like this:

When Mrs. Willis had a stroke, her husband never slept alone. Her daughter never had to go dress shopping for the prom by herself. And her son didn’t have to sit out the Mother-Son dance at his wedding. Why? Because she came to Hospital A…and she didn’t die!

There’s another ad for one of the big downtown hospital’s cancer center (sorry, “advanced cancer center”):

Every cancer, every stage. Your life depends on it!

Let’s see: No one ever dies at Hospital A. And the big downtown cancer center can cure any cancer. That’s certainly what those ads would have you believe. Even the little local suburban hospitals have taken to advertising: Billboards around the neighborhoods, kiosks at the outlet malls, mainly pushing the lucrative stuff like cardiac care and bariatric surgery.

Every time I see this stuff, I can’t help but wonder how much it all must cost. And how much medical care could have been provided to the uninsured instead of enriching the ad execs and billboard owners who are already rolling in dough. Clearly there is still plenty of money to be made in the hospital business, because these people aren’t stupid. They wouldn’t spend this kind of money on marketing unless there was plenty more to be made from it. I believe it’s a little business concept known as “return on investment.” Read more »

*This blog post was originally published at Musings of a Dinosaur*

Light Shed On The Corruption Of The RUC

Interesting [recent] front-page article in the Wall Street Journal (WSJ) about the American Medical Association’s (AMA) Relative Value Scale Update Committee (RUC). From the WSJ:

Three times a year, 29 doctors gather around a table in a hotel meeting room. Their job is an unusual one: divvying up billions of Medicare dollars.

The group, convened by the American Medical Association, has no official government standing. Members are mostly selected by medical-specialty trade groups. Anyone who attends its meetings must sign a confidentiality agreement. [...]

The RUC, as it is known, has stoked a debate over whether doctors have too much control over the flow of taxpayer dollars in the $500 billion Medicare program. Its critics fault the committee for contributing to a system that spends too much money on sophisticated procedures, while shorting the type of nuts-and-bolts primary care that could keep patients healthier from the start — and save money.

I’m glad to see the RUC getting some much-needed scrutiny, and skeptical scrutiny at that. But they miss the point with the “fox watching the henhouse” angle, or at least they paint with too broad a brush. Read more »

*This blog post was originally published at Movin' Meat*

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