Clearly, practitioners could help improve the value of care by reducing variation in practice, a sentinel for quality. They also could help eliminate waste and duplication, thereby improving efficiency, cost-effectiveness and even clinical outcomes (i.e., benefit). That effort may include, but should not be limited to having integrated systems of care, shared savings, bundled payments, or global fees and performance measures that promote care coordination.
practice, performance and pay
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Medicare is expected to consume 18% of the federal budget in 2020, 3% more than in 2010. Indeed, projections are that the Medicare trust fund (Part A) will be below water covering all the hospital bills by 2024.
The practice is getting squeezed; Want ideas? First, don't give up on the idea that small practices are out. Consider them, if for no other reason then they are often better then large pracices that are overly driven to see large volumes of patients. IOW, solo and small practices are still playing an important role, although they may require TLC to thrive.
Reform will fail when practitioners are not getting paid for legitimate work they do. Paying healthcare practitioners fairly is the crux of healthcare payment reform. Here is a brief synopsis of how methods to reign in physician compensation have always failed and nothing was ever solved through cost-shifting or cost-sharing. In brief, various attempts "Reforming Medicare's Physician Payment System" [N Eng J Med] have fallen flat.
Clearly, not fulfilling patients' requests diminishes their satisfaction, but patient-centered communication can enhance that. So what is one to do? Being adept at saying "no" is an art; it should preserve, if not amplify a practitioners' interest in and concern for their patient. This article describes ways of negotiating with patients about specific requests for diagnostic testing, treatment, on-going or changing care.
Want to simultaneously improve the quality, cost-benefit and access to care? This can only be accomplished if health care is less fractionated, the incentives are aligned and someone is measuring and managing--in other words, pay for performance (P4P).
Dear Doctor, "They're just kicking your Medicare fees further down the road." Attached to a bill that extends unemployment, certain other benefits and subsidies for another month is a reprieve* to this October on a threatened 21% cut in Medicare physician reimbursement. Thus, Congress again has failed to address a known flaw in the Medicare rate setting formula--the annual planned rate reduction that is deferred yearly at the last minute.
Resource-based Relative Value Scale (RBRVS) was supposed to reduce some of the disparities in pay and encourage primary care; it has done the opposite--rewarding the more expensive care, particularly the procedures while short-changing the 'cognitive' services To quote Brian Klepper,"Medicare’s payment system, which is the basis for most commercial payment as well, favors specialists in two ways.
Snippet from "Physician Compensation, Cost, and Quality" When we look at pay-for-performance arrangements, we find, naturally, that physicians are redesigning particular aspects of their practice in order to ensure better pay, even if it is at the expense of the "quality of care in other practice areas."
Higher doctor salaries may be justifiable, if the results are better. Here's why.... Caveat: To prove my contention, the following minimum information technology is prerequisite. Get all six (6) items in place and functional and the justification for higher salaries will be obvious. In other words, pay more for better care. The obverse is also true. (Rhetorically, why should we pay a lot for care that is of little or no value?)