Getting Docs to Do Less

Doctors should be paid an amount that covers the typical cost of tests and treatments needed to address a patient's condition.

"Without changes to the way Medicare pays doctors, the fights in Congress over raising or lowering payment rates will continue. And doctors will still have no financial incentive to do what is most important: spend more time with their patients... . Doctors should be paid an amount that covers the typical cost of tests and treatments needed to address a patient’s condition. This strategy — known as “case rate” or “prospective” payment — is standard in American hospitals. The hospital receives a payment for dealing with a patient’s underlying condition rather than individual payments for each test and treatment. This approach offers no incentive to run unneeded tests, and it has been credited with substantially slowing the growth in Medicare payments to hospitals." In other words, "For their time, doctors should be given a stipend for each of their patients. It should be larger for patients with complicated medical conditions and smaller for those who are healthy, and it should not be influenced by the number of services or tests a doctor orders."

In terms of the saga of managed care, this recommendation is old--prospective payment, risk-sharing, capitation, cost shifting and cost-sharing are all about accountability for the cost of care. But, patients (and their families) want the best and with no delay. The question then becomes, 'Is "cost-effective" or "efficient" antithetical to the patient-client's objectives?

In the final analysis, the great equalizer in this perpetual debate will be outcome study.