BREAKING: Docs don't want the way they're paid to change

[Greenbeard]

Shocking stuff. Or not.

We're approaching nearly $3 trillion flowing into the health sector every year and doctors aren't particularly looking to change that.

A new report from insurer UnitedHealth Group shows that doctors have mixed views on the new pay-for-performance model promoted in the 2010 health care law as a means of controlling health care costs and improving quality.

The law has provisions that transition from a traditional fee-for-service system, where doctors, hospitals and other providers are paid based on how many patients they served and the specific treatments or episodes of care for those patients, to new payments models that change incentives in a variety of areas. This new payment reform includes rewards for high quality care, bundled payments to cover a spectrum of providers and treatments for a patient, giving providers a set fee for managing patients care and also giving them a share of any savings.

The report estimates savings from payment reform to be anywhere from $200 billion to $600 billion over 10 years. But the report, released Wednesday at the Forbes health care summit in New York, finds misgivings among providers.

A survey of doctors by Harris Interactive finds that 59 percent of physicians believe that the fee-for-service system encourages them to provide “an appropriate level of care.” Only 15 percent disagreed. Although 37 percent of doctors thought such a system encourages the use of more care or expensive care, 38 percent also said that a fee-for-service system encourages coordination of care. Not surprisingly, the 400 U.S.-based primary care physicians and 600 U.S.-based specialists surveyed, did not favor the idea of a global capitation payment—or a fixed payment per month for all medical services. Nearly 60 percent of the doctors surveyed said that capitation put too much risk on the provider.

 

[AmyNation]

I saw an interesting piece on the news the other night. The ACA fines hospitals who have a high readmittance rate, because a large precent of that is due to infections caused by the hospital.

Well the piece was about a hospital(who 1st complained about the fine and how they would be compensated less for readmitting people) who set up cameras on the floor to watch doctors and nurses to see if they were following hand washing protocol, then they would post the precent at the end of each shift.

They started with less than 10% following, and it increased 90% after they started posting it. It was a total success.


My 1st thought after watching was "hey, something good about the ACA!"

 

[Greenbeard]

That's a good example of the broader point: payment heavily influences delivery. And if we want better results and smarter, more effective, higher quality care delivery we need to pay for care in a way that encourages that. That financial pressure is key to facilitating change among docs and hospitals, even if they try to defend the status quo at first.

As the OP indicates, the readmissions payment policy is just one of many attempts that are now ongoing to change the way care is paid for to encourage better results. It's an exciting time.

Here's a recent story out of North Carolina on how that policy in particular is supposed to work:

To ease the financial sting, hospitals increasingly are trying to manage patients’ health care after they are discharged. Hospital personnel make follow-up calls, schedule doctors’ visits and set up therapy appointments. Duke University Health System is planning to offer apps designed to send prompts and reminders for patients to take meds and report symptoms.

Hospital administrators say the pressure to reduce readmissions is forcing them to take steps that are long overdue – by coordinating with nursing homes and family caretakers to treat health problems early, before they blow up into emergencies.

King saw a difference at Wake-Med on her return visit.

“This time when I came back in, it was more focused, it seemed to me,” King said from her WakeMed recliner, covered up to her neck by a blanket. “The cardiac and respiratory team was really working together. They apparently identified what my needs were.”

The penalties in the federal health care law are designed to reduce unnecessary costs and curb waste. Chronically ill, elderly patients, typically on fixed incomes, are among the costliest in the system; some rotate in and out of emergency rooms as a way of dealing with poor health.

Medicare’s negative reinforcement is already showing results and reducing readmission rates among Triangle hospitals, and administrators here say patients are better off on account of the follow-ups, monitoring and early intervention. The new policy is generating “lots of energy, lots of excitement about the possibilities,” said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association.

That policy, like all of them, may need tweaking in the future (this whole thing is the beginning of a long journey) but this is the direction we need to go.

But the docs and hospitals can be tough to win over.

 

[dblack]

Shocking stuff. Or not.

We're approaching nearly $3 trillion flowing into the health sector every year and doctors aren't particularly looking to change that.

... which is why it hasn't changed.

 

[Greenbeard]

Shocking stuff. Or not.

We're approaching nearly $3 trillion flowing into the health sector every year and doctors aren't particularly looking to change that.

... which is why it hasn't changed.

It's changing as we speak. The transition away from straight fee-for-service and toward more accountable payment structures has already begun.

 

[kiwiman127]

Well, if the physicians don't like it where are they going to go to practice?
The US, Mexico and Turkey are the only developed countries that don't have some form of socialized medicine for their core population.

 

[Quantum Windbag]

Shocking stuff. Or not.

We're approaching nearly $3 trillion flowing into the health sector every year and doctors aren't particularly looking to change that.

A new report from insurer UnitedHealth Group shows that doctors have mixed views on the new pay-for-performance model promoted in the 2010 health care law as a means of controlling health care costs and improving quality.

The law has provisions that transition from a traditional fee-for-service system, where doctors, hospitals and other providers are paid based on how many patients they served and the specific treatments or episodes of care for those patients, to new payments models that change incentives in a variety of areas. This new payment reform includes rewards for high quality care, bundled payments to cover a spectrum of providers and treatments for a patient, giving providers a set fee for managing patients care and also giving them a share of any savings.

The report estimates savings from payment reform to be anywhere from $200 billion to $600 billion over 10 years. But the report, released Wednesday at the Forbes health care summit in New York, finds misgivings among providers.

A survey of doctors by Harris Interactive finds that 59 percent of physicians believe that the fee-for-service system encourages them to provide “an appropriate level of care.” Only 15 percent disagreed. Although 37 percent of doctors thought such a system encourages the use of more care or expensive care, 38 percent also said that a fee-for-service system encourages coordination of care. Not surprisingly, the 400 U.S.-based primary care physicians and 600 U.S.-based specialists surveyed, did not favor the idea of a global capitation payment—or a fixed payment per month for all medical services. Nearly 60 percent of the doctors surveyed said that capitation put too much risk on the provider.

Gee, I wonder where I heard this before.

Oh, I remember, I posted about this before Obamacare got passed, and you posted a lot of studies that proved how stupid I was for thinking that the entire planet would not bow down to the wisdom of progressive activism manifested through government control of medical care.

I would be the bigger man here, but I prefer to say neener neener.

 

[CrusaderFrank]

Shocking stuff. Or not.

We're approaching nearly $3 trillion flowing into the health sector every year and doctors aren't particularly looking to change that.

... which is why it hasn't changed.

It's changing as we speak. The transition away from straight fee-for-service and toward more accountable payment structures has already begun.

People paying for their own stuff is still the most accountable payment structure the world has ever known

 

[dblack]

Shocking stuff. Or not.

We're approaching nearly $3 trillion flowing into the health sector every year and doctors aren't particularly looking to change that.

... which is why it hasn't changed.

It's changing as we speak. The transition away from straight fee-for-service and toward more accountable payment structures has already begun.

Not really. PPACA does much more to preserve the status quo than it does to change anything. Health care prices will continue to outpace general inflation, doctors, hospitals, big pharma, etc, etc.. will continue to be overpaid. The obvious, overriding purpose of ACA was to secure the established interests in the health care game, consolidating control under a mandated regulatory structure.

I'm not sure we'll ever be able to recover from this sellout.

 

[Annie]

Well, if the physicians don't like it where are they going to go to practice?
The US, Mexico and Turkey are the only developed countries that don't have some form of socialized medicine for their core population.

True. Now one wonders where the docs will be coming from? Would you go into medicine today? If you were over 50 and had substantial investments and portfolio, would you not retire, than deal with the nonsense coming?

Many want to punish and 'get people thinking right', meaning your way. You might just find that we're going to facing an absence of docs on the level of rural areas. Worse, the young are not stupid. Regardless of those that feel a 'pull' towards medicine, the writing is on the wall.

 

[uscitizen]

Healthcare seems to be the major industry of the USA.

ONly becuase we cannot really offshore it I suppose.
We have already offshored most of the medicines and such we use.

 

[Politico]

Well that's too bad for em'.

 

[Annie]

Well that's too bad for em'.

'Them' will not feel the change. Indeed, 'them' will be fine. It's the rest of us. But you and your ilk are happy with punishing those that work.

 

[Politico]

Thanks but I didn't do anything.

 

[Noomi]

The like the way they are paid probably because they make more money that way.

 

[geauxtohell]

Well, if the physicians don't like it where are they going to go to practice?
The US, Mexico and Turkey are the only developed countries that don't have some form of socialized medicine for their core population.

True. Now one wonders where the docs will be coming from? Would you go into medicine today? If you were over 50 and had substantial investments and portfolio, would you not retire, than deal with the nonsense coming?

Many want to punish and 'get people thinking right', meaning your way. You might just find that we're going to facing an absence of docs on the level of rural areas. Worse, the young are not stupid. Regardless of those that feel a 'pull' towards medicine, the writing is on the wall.

I can tell you that, on the training end of the deal, no one is fleeing medicine in droves because of any of this. In fact, no one is even talking about it.

The only non-sense you hear about that are usually histrionic mothers talking about how Junior, the pre-med, switched majors because of "obamacare" or what the fuck ever.

I would submit that mom wanted Junior to be a doctor a lot more than Junior wanted to be a doctor.

 

[TNHarley]

I heard something today. Maybe you all can help. The part your employer pays for your insurance is going to be considered earned income and taxed?

 

[Avorysuds]

The consequences to Obamacare will fall into place and be felt 5-10+ years out. It takes time for these things to destroy an industry, it won’t happen overnight. The 100% main issue as to why HC costs rise is due to the obesity rate going up so dramatically and then these people vote for more welfare in HC. Basically, Government tied with people who destroy their bodies put far too much strain on the system. To see people here say doctors and big pharma makes too much money is just hysterical… They only make that money because the demand is there, the demand is there because people can afford to poison themselves to death (literally) and Government helps subsidize that habit.

Government is now struggling to cover the costs that obese people have created and thus we have a "debate" over HC. Most HC conditions are due to obesity, simply being in a health weight range can cut someone’s medical bills down to zero, but that would mean people would have to you know, not eat like shit and move around… Government has gone out of its way to obstruct people from being motivated and I base that on whelp, the fuckin reality we all live in.

 

[geauxtohell]

I saw an interesting piece on the news the other night. The ACA fines hospitals who have a high readmittance rate, because a large precent of that is due to infections caused by the hospital.

Well the piece was about a hospital(who 1st complained about the fine and how they would be compensated less for readmitting people) who set up cameras on the floor to watch doctors and nurses to see if they were following hand washing protocol, then they would post the precent at the end of each shift.

They started with less than 10% following, and it increased 90% after they started posting it. It was a total success.


My 1st thought after watching was "hey, something good about the ACA!"

As nice as that all sounds, there are real problems with these QC measures that the government has implemented (or de facto implented by tying them to billing.).

I would argue that the asinine requirement to obtain the Review Of Systems, where I have to ask you if you have symptoms in ten different organ systems outside of what you are complaining about, causes more harm than good.

For instance, if you broke your clavicle and you come in and say: "I think I've broking my clavicle", after we get that bit of history, I've start asking "Do you have any chest pain, do you have any shortness of air, do you have a fever, nausea, vomiting, abdominal pain, bloody stool, blood in your urine, pain when you urinate, palpitations, a cough, pain in your joints, pain in your muscles, double vision, blurred vision, headaches, or difficulty hearing".

Most of the time the patient looks at me with a blank stare as if to say: "No. I would have told you so if I had that. Were you even listening to me?"

Or worse, the diligent patient, thinking that the oh-so-brilliant doctor must know something they don't (as opposed to simply asking because it is a requirement for billing) starts to get neurotic and interpret any little twitch as one of the above symptoms and start answering yes which warrants further investigation, tests, cost, and potential harm from complications from obtaining those.

At best, it adds time and strain to the patient interaction. At worst, it can harm patients. I would submit that, if a patient doesn't tell you they have chest pain unprompted, they don't have chest pain. In probably thousands of patient encounters, I've yet to glean one useful nugget from the Review of Systems. I feel like an ass doing it, because I feel that if the patient knew the truth, that this is something we do simply because the Government tells us we have to do it for billing, they would be rightfully pissed off.

Also, good luck getting a ROS out of a pediatric patient. That's always fun.

It's the same with infections, i.e. VAP and HCAP. People could handwash the skin of their hands and, guess what? The chronically ill will still catch secondary infections, just as they would on the street.

The burden that is being placed on hospitals could potentially be enough to shut down hospitals like mine, that services a population that is almost exclusively medicaid.

Which runs counter to the whole access to care for everyone things, which means the government is going to have to either change it's position or put more ridiculous demands on hospitals and providers.

I'd bet on the latter.

So be careful what you wish for.

 

[geauxtohell]

Well, if the physicians don't like it where are they going to go to practice?
The US, Mexico and Turkey are the only developed countries that don't have some form of socialized medicine for their core population.

Nowhere.

That is what is so funny about this whole "doctors are going to flee healthcare" thing.

It might push a few towards early retirement, but no one is going to leave the profession as long as they garner a reasonably fair wage for their efforts.