- Joined
- Mar 17, 2003
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- 2,962
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The drumbeat in the news is that our healthcare system is broken because physicians are incentivized by quantity of care rather than quality of care ("from volume to value") I have also heard statements like, "doctors order more tests because they make more money for each test". I don't really think that is how it works. When a primary care doc orders tests and studies, I don't think he or she makes more money.
I also resent the sentement that we care more about quantity than quality. I believe the two are often times closely related (i.e. the surgeon with the highest volume has the most experience and best outcomes which begets more business and more experience. Value begets volume and volume begets value).
Moreover, "the term fee for service" has become a dirty concept. It is important to remember that we life in a market based society where you are reimbursed for each unit produced. We as pathologists make widgits (aka diagnoses), and to say we should not be reimbursed on a per widgit basis goes against our whole economic system.
As we move towards bundled payments and ACOs; hopefully, CMS and others will realize that pathologists don't manage paitients with diabetes. We make widgits. FFS should apply to us. While we can help save healthcare costs via education and lab management, we can't be strangled in a "prospective payment" system.
To make healthcare and medicare work, we should not abandon FFS, we should limit services available to patients whose care is paid for by taxpayers. We need so called "death panels". If you are old with metstatic cancer or demented in a nursing home and in need of a hip replacement, you shouldn't get the rare expensive chemotherapy or a new hip unless you want to spend your own life savings on it. We need to ration healthcare when it comes to public funds.
I also resent the sentement that we care more about quantity than quality. I believe the two are often times closely related (i.e. the surgeon with the highest volume has the most experience and best outcomes which begets more business and more experience. Value begets volume and volume begets value).
Moreover, "the term fee for service" has become a dirty concept. It is important to remember that we life in a market based society where you are reimbursed for each unit produced. We as pathologists make widgits (aka diagnoses), and to say we should not be reimbursed on a per widgit basis goes against our whole economic system.
As we move towards bundled payments and ACOs; hopefully, CMS and others will realize that pathologists don't manage paitients with diabetes. We make widgits. FFS should apply to us. While we can help save healthcare costs via education and lab management, we can't be strangled in a "prospective payment" system.
To make healthcare and medicare work, we should not abandon FFS, we should limit services available to patients whose care is paid for by taxpayers. We need so called "death panels". If you are old with metstatic cancer or demented in a nursing home and in need of a hip replacement, you shouldn't get the rare expensive chemotherapy or a new hip unless you want to spend your own life savings on it. We need to ration healthcare when it comes to public funds.