Commentary: Breaking the rules of health care — paying your doctor | Opinion

The numbers are daunting.

If our country offers affordable insurance and seeks to improve clinical outcomes, we must begin to break unwritten medical rules.

One of the unwritten rules we follow is that the best way to pay a doctor is to trade. Transactional payments are the basis of almost all financial transactions. The seller offers the goods or services in exchange for payment. Here’s how we hire a piano teacher, rent an apartment, and procure Girl Scout cookies. It’s also a way to pay 95% of today’s doctor visits.

In an easier era where doctors can only offer a small portion of the “products” and “services” they offer today, and whenever patients can be trusted, they will receive the best care available at a reasonable price. It makes sense to pay for medical expenses in a transaction.

Recently, researchers and policy experts have pointed out that 25% of the $ 4 trillion spent on medical care in the United States each year is wasted (many of which are spent on unnecessary or ineffective treatments. It has been killed). This is an inevitable and well-documented result of QuidProquare payments in healthcare. However, the damage is not limited to the American economy. It is often overlooked how transactional payments harm patients, doctors, and doctor-patient relationships.

The simple fact is that transactional payments are detrimental to the patient’s health. With a transaction refund, the doctor will be rewarded for fixing certain identifiable problems. When someone has a heart attack, a cardiologist is rewarded for performing angioplasty. When the kidneys and lungs fail, the surgeon receives the cost of an organ transplant.

While these are notable life-saving procedures, 21st century physicians can do even more remarkable things. Prophylactic screening, frequent check-in, and proper dosing can prevent heart, kidney, and lung dysfunction in the first place. ..

Here’s the transaction payment issue: how do you pay someone for something that didn’t happen (such as a heart attack or stroke)? Currently, your GP must file a claim for each step in the process. Doctors must file dozens of claims to help only one patient effectively manage or prevent one chronic illness. Given that 133 million Americans suffer from at least one chronic illness, it’s clear that paying a doctor a deal is a costly mistake.

Payments made by transactions also harm doctors. In the 21st century, insurers have sought to reduce medical costs by reducing payments to doctors and implementing strict pre-approval requirements. In a transactional payment model, these are the most powerful tools payers need to control medical costs and dial back to unwanted services.

As a result, doctors are forced to see more patients per day to maintain their income, spending up to half a day on insurance-related tasks (tracking approvals and submitting paperwork). increase.

It’s no wonder doctors are frustrated, frustrated, and tired (a typical symptom of “burnout”) under these circumstances.

And perhaps most importantly, transactional payments erode the doctor-patient relationship. In a 2019 study, doctors said patient appreciation and patient relationships are the most rewarding aspects of medical practice. Still, 87% of doctors say patients are less credible than they were 10 years ago.

Both the federal government and private insurance companies are trying to solve the doctor’s reimbursement problem with “pay value” and “pay performance” incentives. These programs only replace one form of transaction payment with another, so there is no big difference.

Instead of paying doctors on a visit-by-visit or procedure-by-procedure basis, so-called value-based models reward doctors for achieving dozens of preventative screening goals and other “high-value” benchmarks. Some of these programs have moved the needle to clinical quality.

Instead of quidproqua payment methods, American medicine needs a relationship-based reimbursement model.

It’s time to move from transactional payments to transformative payments

Here’s how a transformative, relationship-based Medicare reimbursement system works:

• Medicare subscribers select their primary care physician as the responsible physician.
• The Medicare and Medicaid Center then pays the doctor a one-time prepayment and provides these patients with a year’s worth of medical care (rather than paying once after each medical service).
• Physicians’ basic rewards depend on (a) the number of Medicare subscribers they care for and (b) the complexity of each patient’s current medical problems. This helps predict the amount of care they need.
• Each primary care physician is eligible for additional payments each year, depending on the patient’s experience. At the end of the year, registrants will answer a series of questions about the impact doctors have had over the last 12 months. Did your doctor help you lead a healthier life? Did he / she help you make good medical decisions? Do you value your relationship? Do you trust your doctor’s recommendations?

The advantages of this transformative payment model are:

• Greater satisfaction. Doctors no longer have to pay for each service, significantly reducing the amount of time they spend on paperwork. Instead of these dissatisfied bureaucratic tasks, doctors can spend their time on something important: helping patients prevent and manage their illness.
• Meaningful difference. Transforming payments shift from incentives given by physicians to the impact they have on patients. Transformational models reward physicians for their positive impact on the patient’s life, rather than assessing them for individual behavioral or clinical indicators. So, after all, that’s why people choose to be doctors in the first place.

Even with an incentive payment equivalent to 10% of the doctor’s salary, the additional cost of the program is relatively low. This is because the income of the primary care physician is a small part of the total medical expenses. And the potential rewards for investment will be enormous. By moving from transactional payments to transformational payments, patients can better manage their chronic illnesses, lead a more productive life, and reduce their risk of experiencing heart attacks, cancer, and stroke. ..

Undoubtedly, the discussion will focus on the written rules and implementation of the program. But it’s time for Congress to set aside the factions.

Otherwise, we expect national medical problems to worsen year by year.