Thursday, March 28, 2013

Here is a shocker- Bogus "commission" recommends abolition of physician fee for service

Fee for service has increasingly become the bogus reason for  all of what is wrong with health care in the U.S. Now a  group of self designated experts deliberated and concluded what they all likely believed at the onset namely that we must eliminate fee for service (ffs) in medical care.Reference here is to the  "National Commission on Physician Payment Reform". See here for the report.

One could get a idea regarding their likely recommendations by considering some who are on the commission.  Here are some of the participants:

Dr. Troyen Brennan who wrote with Dr. Don Berwick about replacing the physician patient dyad in their 1996 book,  "New Rules" was formerly a VP at Aetna and now an executive VP at CVS Caremark. Here is a quote from Drs.Berwick and Brennan from that book:

“Today, this isolated relationship is no longer tenable or possible… Traditional medical ethics, based on the doctor-patient dyad must be reformulated to fit the new mold of the delivery of health care...Regulation must evolve. Regulating for improved medical care involves designing appropriate rules with authority...Health care is being rationalized through critical pathways and guidelines. The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized, individualized decision making.”

 Guess how the author of that paragraph would feel about fee for service for physicians.

Dr. Judy Bigby is Secretary of HHS for Massachusetts.

Dr. Lisa Lotts is a VP at Well Point.

 Somehow the image of a commission of  prominent foxes gathering to make recommendations regarding hen house security comes to mind.


One thing most of the fee for service critics propose is that physicians become part of Accountable Care Organizations (ACOs) and therefore they will be compensated for "quality and not volume of care". Does anyone really believe that physician employees of a ACO will not have volume requirement?

Dr John Goodman in this blog commentary says it better than I can in regard to fee for service and ACOs.

"There is absolutely no support for the notion that ACOs will do anything ― anything ― to reduce costs or improve quality (see this recent NCPA blog, “Question: Why Did Anyone Ever Believe in ACOs?”). It is nothing more than a wish dressed up with high-falutin’ language (sustainable, cost-effective, high-quality, interoperable, coordinated, etc.) In fact, virtually all of the evidence indicates just the opposite ― that the elements of ACOs (disease management, pay-for-performance and so on) are useless or worse."

And here is the money quote:

" ... the problem in health care is not fee-for-service, but third-party payment. Almost everything we do during the course of a day is done on a fee-for-service basis and none of it results in high inflation or poor quality. Quite the opposite. The only difference in health care is that someone else is paying the bill, so there is no constraint on the consumer or the provider of services."


Exactly-health care is largely paid for with some one else's money and those some one elses are doing all they can to limit that spending and increase their bottom lines and demonizing ffs and promoting the new bigger and better HMO ( now renamed as ASOs) seems to be their current tactic.

Sadly, the major medical professional organizations are complicit in this push into the ACOs which cannot possibly fix the health care problems but can put many more nails in the coffin of the fiduciary duty of the physician to the patients. How much individual patient advocacy are you going to see in a large organization in which the physician are the employees?  To what extent  will physicians trained in the era in which the world medical view is that physicians are  stewards of society's resources and that their actions should be controlled by utilitarian based cost effectiveness analysis and directives  be dedicated advocates for their patients?


1 comment:

Phil_in_VA said...

Well OK then. The verdict is in. After looking under every bed for the bogie-man (woman?) causing the skyrocketing health care costs; searching high and low, at the hospitals, at the DME suppliers, at the insurance companies, at the seven (or eight)-figure salaries. NO, it's clear. It's the physicians, yeah, the physicians. That's the ticket.