It's not real progressive health care reform unless it ends "fee for service"

[Teaser]

Ah, I've been wanting to exclude some people from the progressive tent for a while now...

[grantcart]

1. If I am not mistaken one of the agreements made with the blue dogs

(and their most important contribution) is to establish a commission to reveiw a more outcome base system. They would start next year and have the power to introduce a different system in 2011.

[eleny]

3. Cobwebs and crickets come to mind when I see the word "commission"

[grantcart]

5. I don't know if it was a 'commission' or some other device

the point is that there isn't time now to get into such fine engineering changes as changing how fees are paid and the complex issue of building incentives for outcome rather than fee for service. The power was engineered into the bill so that in time experts who are sympathetic to the issue would be able to devise an incentive based schedule that doctors would prefer because it would, in the end, reward doctors who are able to be more effective on the preventative side.

If people think that we should wait until we can work out exactly the best way to replace fee based compensation for, lets say adult diabetes, then this bill will take another 5 years to get passed.

[Teaser]

7. I'm only half serious

but fee-for-service is a recipe for cost nightmares.
We could do better.

[Honeycombe8]

9. That sounds unworkable. People can die, tho everything right was done.

And people can live, despite wrong things being done. Through no fault of anyone.

I don't see how that could work. Besides, health care providers earn salaries and wages, like other people, and deserve to get paid for performing a service.

It's the ins. cos. who are skimming off the top. This causes the providers to raise their fees (double or triple), so that they end up getting paid more. And costs skyrocket.

[grantcart]

12. It works in European systems quite well

For example a person is diagnosed with pre Diabetes.


A yearly contract fee for the doctors services is provided for caring for this patient as long as he is seen by that doctor.


If the doctor can spend more time with the patient and work on preventative treatments so that the patient gets more exercise and diet then the doctor will have a higher profit margin. If he becomes a full blown diabetic and has to come in for intensive treatment then the doctor will make less profit.


These outcome based programs have worked very well elsewhere. While there can be a negative result in any single case a good doctor will be able to significantly increase his/her income by getting their over all caseload to live more healthy.

the Doctor is transformed from a "disease treater and pill pusher" to a health care provider paid one his/her ability to increase the overall health of his case load.

[Honeycombe8]

14. But someone can become a full blown diabetic despite increasing exercise and

changing diet. Through no fault of the care provider or the patient. And the dr. CAN spend more time with the patient about changing lifestyle, and still the patient won't change. Through no fault of the dr.

I like the concept, since it is a big problem that care providers make more $ the sicker we get (conflict of interest with us getting healthier!). But I don't see how it could work and be fair, really. I wouldn't become a doctor under a system like that.

Would you take a job with your employer and agree to get paid only if your employer got more business, or got more clients? If they didn't, you would get paid a minimum. If they did, you'd get paid more. (For work that you directly do that results in that business.)

I don't think that'll ever fly in America. Maybe an EXTRA incentive on top of decent pay, if a borderline diabetic doesn't become a full blown diabetic within a certain number of years. But I don't know how anyone could document that. You just ask the patient if he changed his lifestyle? He'll say yes, even if he didn't. He might think giving up one Dunkin' Donut a week IS changing lifestyle.

[grantcart]

16. It has nothing to do with a particular patient but how the entire caseload is treated

While one patient does nothing the next patient will watch a video and start walking 5 miles a day.


You are too caught up in a particular case and are not seeing that the doctor is going to be compensated on 200-300 patients. His performance will be judged and compensated in comparison to his peers who are working on similar averages.

[Honeycombe8]

17. Ah....I see. I like the concept, if they could make it work. The current system...

I agree, is that the sicker you get, the more they get paid. There is a disincentive for you to get healthy, esp. by making lifestyle changes and not by taking pills.

If they could make that work somehow, I think that'd be a very good change.

I recently had my annual checkup. I'm a 55 year old woman. I try to lead a health lifestyle, although I struggle with my weight (but I never give up; and I'm just a tad overweight sometimes, not overly fat or anything). My only health issue is the typical middle aged mild arthritis. In the space in the form where you list your current medications, I put "none." When the dr. is with me, he's looking at my info, and he said, "It says here you don't take any medications." I say, "Yeah, that's right." He repeats, "You don't take ANY medications?" (he doesn't believe me) I just say, "No." Then we move on after he gets over that.

The point being...doctors seem to WANT us to be loaded up on pills and have "conditions." Doctors of late seem almost disappointed to find out that a patient is healthy, doesn't take medications, leads a relatively healthy lifestyle. Personally, I think it's because they don't make much money from patients like that. It's pathetic, and makes me not trust them.

[undeterred]

2. Why do you want to exclude people from the progressive tent?

[nemo137]

4. It's a bit of a hobby around here.

The idea is to get your tent down to a snuggie.

[undeterred]

6. So it can be drowned in the toilet?

[Teaser]

8. I just want to be like the kewl kids

.

[alcibiades_mystery]

10. And ambulances fly on rainbows

And all our kids are neuroscientist-Olympic swimmers!

Otherwise, how on Earth could anyone call it "robust?????"

:rofl:

[Davis_X_Machina]

11. Massachusetts, as a result of what it has done so far,

is looking at requiring capitation payments instead of FFS. The Blues have started the change-over.

[stray cat]

13. I think we really need that as much as anything but I don't hear much about it

[jeanpalmer]

15. If you eliminate the fee

the service provider is going to eliminate the service. He's not going to provide it for free. It's basically is letting the government or insurance apparatus determine what services you can have rather than let the doctor decide. It is touted as a cost reduction technique but in reality it represents service reduction and stripped down healthcare.