Hospital Savings: Salaries for Doctors, Not Fees (NY Times)

[salvorhardin]

An interesting article in the NY Times extolling Bassett Healthcare in Cooperstown, NY as an ideal model in both lowering health costs and improving quality of care. Bassett, whose doctors are salaried rather than receiving fees for services, has managed to deliver healthcare at costs that are lower than 90% of all other hospitals in New York State while being ranked in the top 10% nationally for quality of care.

Dr. William F. Streck, the longtime president of Bassett, said the hospital paid salaries that were competitive with the money earned in a fee-for-service setting. Some fee-dependent physicians, though, either by working hard or by providing excessive treatments, can make more, an ability doctors trade associations have long defended.

“Everyone knows that the Bassett model is the right model,” said Senator Charles E. Schumer, a New York Democrat involved in negotiations over health care legislation. “The question is, How do you get from here to there?”

It is a question that has plagued lawmakers and medical experts for nearly a century. As early as 1910, Abraham Flexner wrote a landmark report that argued teaching hospitals should be staffed only with salaried doctors. In 1970, the Carnegie Commission released a report calling for drastic improvements in rural health care, and highlighted Bassett as a model.

But for some, wages are not enough. Dr. J. Turner Stauffer, a gastroenterologist in Thomasville, Ga., left Bassett 10 years ago. He has four children, including two of college age.

“To provide for my family, I felt I needed to be reimbursed on a fee-for-service model,” Dr. Stauffer said. “I make three to four times what I was making there, although I don’t know what my salary at Bassett would be now.”

Full article: http://www.nytimes.com/2009/07/25/health/policy/25doctors.html

For what it's worth, I can attest to the fact that the care at Bassett is top notch. Especially in the past fifteen years they have worked very hard at humanizing healthcare and putting together a tightly knit, integrative approach. It's rare to show up for an appointment with your primary care provider and find that he or she never got the results of your tests.

That's not to say there aren't any negatives because there are. Bassett is a teaching hospital with a large number of transient doctors and interns. It is all too common to find that the nice, smart, guy or gal who treated you last month has already moved on somewhere else. Certain primary care providers are more popular than others so you might not be able see the doc you want, leaving you to deal with someone who might be personally less desirable. And Bassett's social workers could be, well, a bit more engaged and helpful.

Overall though, Bassett comes out far ahead of most other hospitals. Frankly, I wouldn't be alive today and typing this if it hadn't been for Bassett's docs, nurses and staff.

[Mojorabbit]

1. The days of solo family practices are just about over

My husband has been practicing for over twenty five years. No one coming out of school now is opening their own practice. They are going to work for hospitals who are setting them up in practice. I don't think it bodes well for autonomy of decision making for the physicians. My hubby can make house calls if he wants, he can see people for free, etc which he does. He couldn't do that as an employee.

[sharesunited]

2. The ethic of what is expected. Law firms donate pro bono time to indigents and non-profit causes.

No reason why an organization employing staff physicians can't do that.

[Mojorabbit]

3. The hospitals

are going to make a profit. Big hospital chains have eaten up most of the small hospitals in this country.
They are not setting up physicians in practice for nothing. When you have to wait for the hospital to give the ok, you have lost something in your personal relationship with your patient as a physician. It is just the way it is now. Just making an observation.

[Celebration]

4. Cleveland Clinic also uses salaries

And the health care there is excellent, and at lower cost. At least that is from a report on CNN.