August 6th, 2009 by GruntDoc in Better Health Network, Health Policy, Opinion
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The Happy Hospitalist, generally an excellent blogger, wrote yesterday about how salaried docs must be delivering better care than those greedy FFS docs, because the Cleveland Clinic does a terrific job with docs on a salary. I suspect their excellent outcomes have nothing to do with reimbursement model and a lot more to do with systems and a strong gatekeeper model.
He totally missed the elephant in the room in the Big Group Clinic model: who gets the money for doing the work.
He cites as an example a GI doc who left the Clinic for independent practice and quadrupled his income. Let’s say he’s working as hard as he did in the Clinic; is he billing more than the Clinic did? I doubt the Clinic wasn’t billing the usual amount for the work, so 3/4 of this docs’ billing went where?
I suspect it went into the overhead of the Clinic. This isn’t a knock on them, it works for their group, so fine. Other groups do essentially the same thing. It’s legal and morally defensible, and some docs don’t mind being salaried.
Salaried docs in a big Multispecialty Clinic have different incomes, but not as radically disparate as the non-clinic model. As a way to somewhat equalize RVRBS issues it works (I wouldn’t want to be in the room when salaries come up, though).
What salaries do not do is get docs to work harder, see more patients. Some docs are very dedicated, motivated people who would work for rent and grocery money. Others on a salary would do the minimum: if every patient is more work and more liability without more pay, well, why work more/harder? As an incentive to produce nothing beats getting paid for it.
(This isn’t an endorsement of excessive or un-necessary procedures; there are greedy jerks in all professions).
Also, a happy side effect of getting paid for what you do rather than for having a pulse is those who work hard resent those that don’t (but who would make the same on salary) a whole lot less. Way less inter-group stress.
Salaries aren’t all bad, but they’re not the Key to Great Healthcare.
Discolsure: I’ve worked ED’s both ways, and much prefer fee for service.
*This blog post was originally published at GruntDoc*
July 21st, 2009 by GruntDoc in True Stories
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The patient with a loving family, a job, good insurance and an abnormal test. Terrible.
When they come in, with their abnormal test (a sono in this case) from an outside place, from a doctor who sends them to your ED with ‘you need more tests’, it’s hard to keep the stiff upper lip. The family, well dressed and pleasant, just make it worse. I know what’s coming. I’d encourage them to run for the door, if I thought it’d help.
The sono usually says “…blah blah blah mass in the blah blah…further imaging is recommended…blah“.
While this usually isn’t a true emergency, let’s face it: the patient deserves an answer and their doctor has given up (or in) and has sent them to me. (And it’s not like I don’t know how to order CT’s, I do).
While waiting for the CT you imagine it’s all going to be nothing, unlike the ones before. Very very occasionally it’s good news, and relief all around.
The vast majority of the time that CT has been utterly horrible news for everyone involved. There are tears, and referrals, and ‘…I don’t know for certain, you need a biopsy, because diagnosis leads to prognosis…’ and I feel rotten for about a week. Unlike the family, for whom I’ve just unmasked Death, who get to have him as a constant companion.
I don’t know if it’s because they seem so normal, or I see myself in everyone in the room, or guilt. Dunno. But it’s horrible.
*This blog post was originally published at GruntDoc*
June 25th, 2009 by GruntDoc in Better Health Network
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Bad news? At least 47 different signatures.
Good news? It arrived mostly prefilled. Over 100 pages.
*This blog post was originally published at GruntDoc*
June 21st, 2009 by GruntDoc in Better Health Network, Humor, True Stories
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Even when it crashes:
(it says “Cannot Quit”).
*This blog post was originally published at GruntDoc*
May 18th, 2009 by GruntDoc in Better Health Network, Humor
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Fort Worth soldier’s, um, boxers make him famous | Fort Worth | Star-Telegram.com
Army Spec. Zachary Boyd, a 2007 graduate of Keller Central High School, was in his sleeping quarters this week when the Taliban attacked in the rugged mountains of eastern Afghanistan. Boyd rushed to a defensive position clad in his helmet, vest and boxers — the pink ones decorated with the “I Love NY” slogan.
Dude’s from Fort Wort. “I Love NY” Boxers. Geez.
Thank you for your service. Get some Texas undies.
*This blog post was originally published at GruntDoc*
