Recently in the New York Times I saw an invited editorial by Pamela Hartzband (a Boston Physician) and her husband Jerome Groopman (a Boston physician who wrote How Doctors Think). The editorial was entitled How Medical Care is Being Corrupted (http://www.nytimes.com/2014/11/19/opinion/how-medical-care-is-being-corrupted.html?_r=1).
Drs. Hartzband and Groopman assert that pay for performance is not good for health care because it will incentivize physicians not to do what’s in the best interest of their patients. Of course, incentivizing can lead to unintended consequences, but I would assert that our current fee-for-service system has more damaging consequences.
A few days later my former health care policy teacher wrote about this op-ed in his blog (http://www.managinghealthcarecosts.blogspot.com). He wasn’t impressed either. He felt that the perfect way to compensate physicians doesn’t exist, and not holding physicians accountable for providing evidence-based care isn’t a good idea. In addition we need to hold systems accountable for not causing unnecessary harm.
Are they suggesting that fee for service is better? And hasn’t created corruption? Mmmm…
Current pay for performance formulas and strategies are far from perfect. The triple aim in its simplified version contains a paradox for sure – better population health and better care for the individual patient? What? And add better cost to that and you get a triple paradox, especially when you consider that no one in health care wants to be paid less.
Could pay for performance lead to gaming of the system and undesirable behaviors? Probably. Would it be worse than what we have now? Probably not.
Hasn’t the current reimbursement system led to poor quality, unreliable safety, overuse, misuse and underuse? Haven’t physicians made decisions about what kind of medicine to practice, where to practice, what kind of patients to care for and what to do for those patients based on our current fee for service reimbursement? Don’t we essentially have a corrupt health care system now? Perhaps I’m being too negative, but the Hartzband-Groopman op-ed by not addressing these questions at least a little lacks some credibility.
Physicians have often elevated themselves to a mystical high road, creating a façade of selflessness and high morality. Drs Groopman and Hartzband have only repeated this cliché in their op-ed. The reality is that physicians have repeatedly demonstrated that they are merely human and their motivations are prone to selfishness. In fact, their op-ed suggests this. Physicians’ decisions ought to be centered on the needs and goals of the patient and evidence-based. We could add the needs of the community and population as well. They need to be fairly rewarded for doing their job well and for the quantity at which they do it. Balance is the key.