Practice good medicine, the rest will follow

Last week I got an incentive check from an insurance company. That’s how things are moving in health care. Patient out of pocket costs are going up, and doctors are getting reimbursed via incentives that no one seems to understand.

Some companies want special forms filled out, some want us to meet certain arbitrary-seeming benchmarks, and for the life of me, I have no idea how to even figure out all these different programs.

One company now lists me as “meeting quality standards” but not meeting “cost-effectiveness standards”. I requested the data on that one: I’m at the peak of the bell curve. Apparently I need a few more SDs to the left to make it. These results are posted on their website and sent to members.

My best doctor-patient relationships do not develop from an insurance website but from personal recommendations. Yes, patients are paying more of their health care costs, but the decisions whether to spend money happen in the exam room. If I think the patient needs a test, I recommend it. If they feel they cannot afford it, we discuss it some more and come up with a reasonable plan.

I’m not sure I care about what the insurance company thinks, but that’s probably naive.

My incentive check mentioned at the top was for $5.92. I’m going to go with a strange philosophy: practice quality medicine based on the latest evidence to the best of my abilities. Hopefully the rest will fall into place.

I might not be cost-effective when I suspect a cancer and get all the diagnostic studies done at once, but it’s better for the patient, so I’m going with it.

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  1. These incentives are trying to move care on a population based level but run the risk of affecting care on the individual level.

  2. Vicki

     /  November 24, 2014

    I wonder if the members who see those data are being told that the criteria are set up so that, by definition, only a minority of doctors will meet cost-effectiveness standards. And that everyone getting twice as good wouldn’t improve those numbers.

    The standards that I care about as a patient are ones that could, in theory, be met by everyone. If you save my life, I’m not going to resent that your colleague saves someone else’s. I would rather have my doctor average a ten-minute wait for appointments, and be the worst in the county on that standard, than average a 40-minute wait and have that be the shortest wait in the county.

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