May 18th, 2009 by KevinMD in Better Health Network
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Paying physicians via capitation was soundly rejected by patients when it was tried in the HMO era a decade ago.
Massachusetts is trying again. According to a state commission, they recommend “replacing fee-for-service with a system that would use a single payment to cover most of a person’s care for an entire year.”
The last time this was tried, patients rebelled as it was perceived that there was a financial incentive for doctors and insurers to deny care. And they were right. Bluntly put, it’s the only way to control health care spending.
Some are skeptical that Capitation Version 2.0 will work. Hospital CEO Paul Levy feels that doctors and hospitals will be at risk of being caught in the middle: “You also need to let the public know what the new environment will be for their care so doctors and hospitals are not caught in the middle, the way it happened during the last experiment with managed care. If the Commission does half the job in its recommendations and leaves the rest to be fixed in the future, it will leave us will a lot of unintended consequences and will undermine the good that might otherwise come from a new payment scheme.”
Health insurer CEO Charlie Baker echoes my skepticism about whether patients will accept the implications of this new model. In addition to the fear that doctors will be incentivized to withhold care, patients will also worry about a possible “restriction on their ability to see any physician they wanted to see.”
But, the bottom line is that saying “no” is the only way to control costs. Whether patients will accept that fact will determine whether these payment reforms will be successful.
*This blog post was originally published at KevinMD.com - Medical Weblog*
May 11th, 2009 by KevinMD in Better Health Network
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One question that occasionally comes up is whether doctors should be paid a flat salary or not.
Currently, the majority of physicians are paid fee-for-service, meaning that the more procedures or office visits they do, the better they are reimbursed. This, of course, gives a financial incentive to do more, without regard to quality or patient outcomes.
One proposed solution is simply to pay doctors a flat salary, with bonuses for better patient outcomes.
Well, according to a recent Kaiser/NPR poll, that idea is a no-go for patients. 70 percent of patients think its better that a “doctor gets paid each time they see you,” while only 25 percent think a yearly salary is better.
As an aside, I find it interesting that any public poll result that goes against the progressive health policy agenda is considered a “weak opinion,” but really, this isn’t a surprising result.
Economist Uwe Reinhardt hinted at the cause when he said that most Americans believe “that they have a perfect right to highly expensive, critically needed health care, even when they cannot pay for it.”
Perhaps the public believes that a salary is similar to the capitation debacle in the 1990s, where doctors were paid a fixed fee, which gave them an incentive to deny care. And any perceived attempt to restrict care will be met with visceral opposition by the American public.
Which again shows how difficult it will be to engage patients with any dialogue that involves cost control.
*This blog post was originally published at KevinMD.com - Medical Weblog*
May 3rd, 2009 by KevinMD in Better Health Network
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Bolstered by the stimulus, there’s no doubt that there’s a significant push for doctors and hospitals to adopt digital medical records.
I’ve written before how we’re essentially throwing money at Windows 95 technology, but now, as an article from BusinessWeek points out, there’s a real danger in moving too fast.
Somewhat under-publicized were the incompatibilities with older systems in the Geisinger Health System, which after spending $35 million on software, noticed a spike medication errors that required another $2 million to fix.
Or what happened at the University of Pennsylvania, which found medication errors stemming from software designed to prevent mistakes.
Worse, there is no national database tracking the errors that are caused from electronic medical records. Because most of the programs are not open-source, confidentiality agreements meant to protect proprietary technology also serve to hide mistakes.
Ideally, these issues need to be resolved before throwing more money into bad technology. But, because of the intuitive notion that technology automatically improves health care, no one seems to be advocating a more cautious route which may, in actuality, better serve patients.
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Better Health Editor’s Note: Please read this post for more in-depth coverage of how difficult it is to transfer health records electronically.
April 30th, 2009 by KevinMD in Better Health Network
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Why yes, you can.
From a German collection of 30 illustrations showing how you can die from electrocution. Uplifting.
(via kottke.org)
*This post was originally published at KevinMD.*
April 20th, 2009 by KevinMD in Better Health Network
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Walgreens made some headlines with their program to give free acute care services to those who are unemployed.
Before you think that they’re doing this out of the goodness of their hearts, Jaan Sidorov gives a more practical reason.
Doctors rarely would drop patients who have recently gone on Medicaid, or worse, lost their health insurance altogether. Why? As Dr. Sidorov writes, “Today’s patients with no or non-remunerative insurance were not only yesterday’s richly insured but tomorrow’s also. These providers know that when the economy eventually turns around, these patients are going to join the ranks of the employed/insured.”
Walgreens is applying the same principle. Today’s uninsured patients will, more likely that not, have insurance in the future, and will repay Walgreens back for helping them out during these tough times.
So, rather than patting Walgreens on the back for their kindness, you should be noting their business shrewdness instead.
