Comments on: Public-Plan Option: Sustainable Growth Rate Formula On Steroids?

By: The American Spectator : AmSpecBlog : Rand Paul and Medicare Physician Payments

The American Spectator : AmSpecBlog : Rand Paul and Medicare Physician Payments — Mon, 17 May 2010 16:37:38 +0000

[...] Clever. And it will indeed be an attractive line of attack for Paul's Democratic opponent, assuming (as seems likely) that he wins the Republican primary tomorrow. Frum fails to mention something rather important, however: the Sustainable Growth Rate (SGR) formula Paul is quoted as criticizing is widely viewed as a disaster. [...]

By: There Will Not Be Health Care Reform in 2009 Without Republican L

There Will Not Be Health Care Reform in 2009 Without Republican L — Wed, 26 Aug 2009 10:20:01 +0000

[...] [...]

By: What Happens To The Patients? | TAKEbackMEDICINE.org

What Happens To The Patients? | TAKEbackMEDICINE.org — Fri, 26 Jun 2009 05:39:40 +0000

[...] doctors will be the first at any dinner party to complain about long days, endless patients, poor reimbursement and hospital politics, these same doctors show a dedication to their work that is very difficult [...]

By: cdeshazer

cdeshazer — Mon, 15 Jun 2009 12:01:17 +0000

Great points! We need to be realistic and not risk more unintended negative consequences with ideas that have already been proven not to work. As Atul Gawande so eloquently exposed, a cost driver we did not want to admit to or talk about is doctors gaming the system. He focuses on doctors but all providers do the same thing including hospitals, home health, etc. But this is simply based on the competitive culture of physicians. Due to the real and threatened blunt instrument of arbitrary across the board Medicare and Medicaid cuts, physicians saw their incomes dramatically drop. This after sacrificing youth to years of training and creating sometimes enormous debt. You combine the competitive culture with the survival instinct and you get ethically trained and professional doctors degenerating into system gamers. In many cases this is not greed but the need to pay back debt and take care of their families. The pressure to survive tempts anyone to test the boundaries. The poison was introduced by the third party payer system. As well-intended as it was, this system focused on unexamined payment for quantity rather than quality. Guess what we got, quantity increases and variation not explainable by quality clinical decisions. That is the root cause we have to fix. I am an internist who has worked in the Kaiser Permanente system where the insurance company is joined at the hip with the doctors. This has forced an alignment of incentives and payment structure that allows doctors to make clinical decisions unencumbered by how it impacts their income. That situation is the essence of what we need in order to allow doctors to be doctors. I see pay-for-performance as a directionally correct shifting of focus to process/outcomes but we do need something more dramatic. We need a model of P4P on steroids.