Impact of “Fee for Service” payment

I haven’t backtracked to the original article this editorial cites. In my view, it looks like big evidence of the impact of FFS (fee for service).

Quality Care at Bargain Prices

[Among] the top five teaching hospitals … UCLA was the most extravagant, averaging some $93,000 per patient. Johns Hopkins, at $85,000, and Massachusetts General, at $78,000, came next. The Cleveland Clinic, at $55,000, and the Mayo Clinic, at $53,000, were far more cost-effective.

…. patients usually do no better — and often fare worse — where the spending is highest….

Few will be surprised to discover that doctors in high-expenditure institutions are typically paid on a fee-for-service basis, which means they earn more if they do more. Mayo Clinic doctors, by contrast, are on salary and have no financial incentive to do anything more than the patient clearly needs. …

It’s just starting to sink in to me: this editorial (if it’s accurate) seems to suggest that for all practical purposes, the most expensive hospitals pay doctors on a commission basis. That is CREEPY.

Hey, insurance companies, how do you like that?

Somebody please correct me. Fool that I am, I keep thinking health care ought to be organized around what’s best for the patient. It’s not?

Change note: reflecting on the comment from md@anonymous, below, I’ve removed the word “exclusively” from the last paragraph.


Posted in: reforming hc




3 Responses to “Impact of “Fee for Service” payment”

  1. Anonymous MD says:

    Exclusively? You mean, *excluding* the welfare of the physicians, the nurses, the radiology techs, the phlebolotomists, the patient’s family, the community — and of course the co-insured people who collectively bear the costs of treatment of an individual? Its not just semantics – its a tightly connected fabric that keeps the system working. Pull one thread hard enough and the whole thing unravels.

    Currently most primary care docs are getting killed trying to take care of too many patients with not enough time. Try telling them that their welfare should be excluded from the calculations. Actually, don’t. They are dropping out at an unsustainable pace as it is.

  2. > You mean, *excluding* the welfare of the physicians, the nurses …

    Goodness no. My wording didn’t take into account that this might be read by new visitors who don’t know me, and I apologize for that.

    Participatory medicine and patient empowerment don’t in any way mean beating the crap out of providers. That’s made clear by the white paper on this site, which I urge everyone to read – it’s visionary. (I wasn’t involved in writing it.)

    When I started my own blog last fall, I started with several thank-you posts to the caregivers and organizations that played beyond-pivotal roles in beating my disease. Also, my CaringBridge journal shows, month after month, my trust and partnership with my MDs, RNs, LPNs, radiologists…

    I long for the days of long ago when I grew up with family doctors; I’ve had carefully-chosen primary doctors most of my adult life; I’m now actively engaged in this blog, this “movement” (as I call it) of participatory medicine, in which patients work with their caregivers. (Notice what it says at the top of this blog – “Because health professionals can’t do it alone.”)

    I’m acutely aware of the strain on the primary care system, and I’ve recently become aware of the research being done by the Patient Centered Primary Care Collaborative to document that better availability of primary doctors correlates with better outcomes. One of their objectives is to *pay* doctors for common-sense care moments that they don’t get paid for today – things that are no longer funded in today’s world (in the US).

    (And, btw, I have several family members and close friends who are MDs, RNs, PTs, etc.)

    So I guess I took it for granted that anything I said was inside the presumption that the caregivers need to be honored, not beaten to death. Nothing could be farther from my heart. I was just talking about apparent organizational “design goals,” as judged by their policies and subsequent results.

    Reading the NY Times editorial, I realized that during my adventure last year, I would have been really irked if I’d been given a bunch of things I didn’t need, just to rack up the billings. I am not a cow to be milked, nor a SSAN on which to hang “up-sell” reimbursement requests.

    Feel free to write me, here or at epatientdave at comcast dot net, if you want to discuss more. Believe me, I’m on the side of *everyone* having better outcomes. A healthier system benefits me, too. And it’s the system where my descendants will seek care, too, and I want it to be well.

  3. Susannah Fox says:

    Maggie Mahar just posted an essay containing the following quote:

    Now, I understand not wanting to have ridiculous referrals. I understand not wanting to increase your already busy workload. I understand that being a surgeon is very time intensive already, so the doc in question probably didn’t need more work. But the thing is, it wasn’t a drunk with a broken jaw, an elective tonsillectomy, or even a fish-bone stuck in the throat. It was a child who might have died.

    Well, I guess Hippocrates didn’t cover that scenario. You know, sick child from another town. After hours, and all that.

    I recently spoke with someone who said doctors in her community are urging their children to go to Wall Street instead of medical school — it’s where the money is. Yikes.

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