Sen. Coburn and I Agree
As reported by Ezra Klein:
“I’d change all physicians to time instead of fee-for-service,” he says. “What we’re doing with fee-for-service, and most people don’t realize this, is when you go to the doctor, they have this pressure to see X number of patients a day to meet their numbers.”
If we cut payments to doctors, Coburn says, “they’re going to cut the time they spend per patient. When a patient is in a room and you haven’t used your skills as a physician to really listen, you walk out and cover that absence of time by ordering tests. So if you say here’s all the hours we’ll pay for if you’re a Medicare doctor, and we can actually audit that time, doctors would have to demonstrate proof that they’re spending this time with patients.”
That wasn’t, I noted to Coburn, a policy that appeared in any of the bills he had sponsored, a fact he acknowledged with a laugh. “I didn’t put that in there,” he said, admitting the idea has little political support. “It’s just something I’ve thought about a long time. Nobody should be seen for less than 20 or 30 minutes if you’re doing this properly. And if I knew I was going to get paid for my time I wouldn’t be in a hurry to see the next patient.”
That’s true.. physicians average what, 8 minutes per patient?
Time is money..
If paying by time reduces the number of patients that a doctor sees, care availability will plummet. Is that a good thing?
I could not agree more with this point. Doctors too often rush appointments. A lot has changed.
I have thought about this a lot over the years. Any dictated payment system has its drawbacks. Pay by service, you get more (maybe too many) services. Pay by time, you get lots of time but maybe not enough services. Pay per patient (capitation) and you get under-treatment.
The problem (as always) is that a third party is dictating the payment arrangement between the physician and the patient. Let the patient control the money and you will demand what works best for you and the doctor can agree to it, or not, depending on what works best for him. Or the physician will lay out his fee schedule and you can agree to it or not. Initial visits might be by time, follow-ups might be by service, some might be by retainer. Plus you can pay more to get the best Doc in town, not so much to get someone less experienced.
There is no magical formula. That is why avoiding market dynamics never works.
Sen. Coburn would know… he’s a doctor.
Hedge fund managers get paid by performance, the storied 2 and 20. Doctors take on patients for a fixed annual fee. If a patient does well, the doctor get’s more, if not they don’t. And don’t respond it’s the patients fault or what about they just get patients that are too sick. Market conditions are vary. Some fund managers do well regardless, year after year. Others don’t.
Getting away from fee-for-service medicine is worth considering. But I’d want some type of bundled payment to provide an incentive for doctors to look for cost-saving ways to treat me. Keep in mind: There’s nobody slower than a plumber being paid by the hour! You almost need a reference point to make sure they’re still alive!
so this would create a cap on the amount of hours that a doctor can report to be reimbursed by Medicare? Otherwise why wouldn’t the doctor keep a patient longer?
What’s wrong with letting patients spending their own money interact with suppliers offering services and letting the prices be determined from there?
Do unregulated dentists charge for time? Does the procedure matter? What about vets? We all know that lawyers charge for time, in a way that has absolutely nothing to do with the time they spend with the “patient.”
What is it about health care that encourages people to run from basic economic principles?
“What is it about health care that encourages people to run from basic economic principles?”
Health care can’t follow what you call “basic economic principles” because the consumers will never be capable of being informed rational actors. You can pick a better or cheaper meal, in health care there’s a standard of care dictated by the state of the art. You can’t buy better no matter how much money you have. As a society we’ve decided that everyone is entitled to that standard of care.
In response to August’s comments, ” If paying by time reduces the number of patients that a doctor sees, care availability will plummet. Is that a good thing?”
Yes, the number of service provided would decrease, but on the other hand, patients would be getting better care from their doctors, more attention from doctors towards specific cases studies.