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The Charter ( Medical Professionalism in the New Millennium.A Physician's Charter) did not deal with just the important relationship of ...

Friday, January 30, 2015

As the destroy fee for service movement ramps up just remember there is no perfect compensation mechanism

 The Obama administration is ramping  up the campaign against medical  fee for service and claiming they want to pay for quality not quantity of care. See. Dr.Paul Hsieh (of the blog We Stand Firm)  remarks about that issue here. It is really about cost control.

Quoting the economist, Arnold Kling:

"Keep in mind that there is no perfect system for compensating doctors. For example, if you pay them a fixed amount of money per patient, then their incentive is to see a lot of healthy patients and avoid the sick ones. If you pay them a fixed salary, their incentive is to work short hours. If you pay them for “quality care,” that means that a central bureaucracy, comparable to IPAB, has to define the meaning of quality."   

Of course it is all about incentives.

And remember Goodhart's Law- when a measure become a target it looses its value as a measure.Further many of the so-called quality targets do little to enhance patient care and some can be harmful,remembering the four hour pneumonia rule.

The various rent-seeking special interest groups  and certain members of the progressive medical elite have considerable control of the current narrative and we will hear more about the horrors of fee for service and nothing about the incentives physicians face in a capitated system or as employees of large vertically integrated health care conglomerate..

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