Paying Physicians Not to Work
Here is a reform idea borrowed from the agricultural subsidies program:
Every American medical community has physicians whose typical utilization patterns exceed the average for their specialty by more than two standard deviations….
Physician Fallow would offer the identified doctors a generous stipend not to practice medicine or surgery for several years. In exchange for the promise to do nothing medically related, fallow physicians’ pay could be set generously, say, at 75 percent or even 100 percent of the average of their last three years’ income.
The quality, safety and cost benefit from taking these super-utilizer physicians out of commission would be immediate and huge. Millions of patients would avoid unnecessary procedures, escaping risk of serious harm or even death, and saving money for purchasers. Complication rates and hospital deaths would plummet. Physician Fallow would produce better, safer care without health plans telling doctors how to practice medicine. It would simply reduce the number of physicians clearly practicing non-evidence-based medicine and surgery.
Here’s what I see as the major problem: Wouldn’t all doctors have an economic incentive to become high utilizers?
Full article on David Kibbe and Brian Keppler’s Physician Fallow.
The notion of paying farmers not to plant crops makes little sense. The idea of paying doctors not to work makes even less sense.
A lot of physicians would come out of retirement to get paid for not working. Wouldn’t there have to be work quotas set for working physicians, so they don’t work too much?
I agree with your reservation. It seems impractical.
I also have a problem with this. Doesn’t it amount to paying doctors to be bad doctors.
This works so well in North Korea, why not try it in the U.S.?
This sounds a lot like Dr Sam’s Modest Proposal that he posted a few years back.
http://drsamonline.com/2008/05/20/uncategorized/dr-sams-modest-proposal-with-apologies-to-jonathan-swift/
Sounds like he’d be willing to participate in this scheme. 🙂
A typical health policy suggestion: focus on what the physicians do without any measure of whether what they are doing helps the patient. Maybe the high utilizers are high utilizers for good reason. Like they see the hard patients, or have better results.
This is incredible. I thought the looming problem was a physician shortage?!?! These chaps propose to maintain the fee-for-service system but have a central bureaucracy dictate to some doctors that they have to stop practicing. In Canada, this means that some specialists work until around Labor Day, when their budgets cap out and they go on vacation for the rest of the year!
I can’t believe that anyone thinks that this proposal, even though Dr. Kibbe & Dr. Keppler made it in good faith, would result in anything other than very blunt hard budgets made to satisfy the needs of government accountants, rather than reduce wasteful care.
I’ve always been leery of the notion that we have to cut waste in health care anyway. Any organization has waste. Even self-employed individuals at home waste time and resources! Health care is massively complex: It is not possible that the optimal level of waste is zero. It is more likely that they’ll cut muscle and leave fat behind.
This seems too silly to be a serious proposal. Why not tax high utilization physicians? Paying them extra (especially if you don’t force then to get extra training or work with lower utilization physicians) is the worst idea I have heard all week.