"Global Payments" Healthcare System, Discuss
 

This is getting some press lately. Instead of the present system whereby each individual test, procedure, etc. is billed for (usually at insanely inflated rates), a provider would be evaluated periodically on "wellness metrics" and be compensated based on the aggregate performance of its care (i.e. fewer sick people = bigger payout).

Sounds like it has some merits but the biggest problem I have is who enforces the standards and performs the metrics analysis? Government? Oversight group? Individual insurance companies? Someone else? There's obviously a lot of room for corruption to enter this.

Just curious to hear some perspectives/opinions on this idea that's being batted around...

Just off the top of my head... Wouldn't providers just cherry-pick patients?

Guaranteed somebody de-rails this thread to the dungeon! :D

Think about it. 30% of time in the office is spent trying to convince people to take the prescribed meds/doseages.

How many other professions are paid based on a global fee? Lawyers? Na. Mechanics? Na. It's the nature of the beast. Do more work for sicker patients and get paid the same? Nuts.

EDIT: I forgot about the exercise, lose weight, and stop smoking stuff. Make it 60% of the office.

What's the goal, lower cost? better care? more widely available care? I'm or anything that improves our current system.

I don't see how that would be a workable system. You would have to penalize the doctor for non-compliant patients.

Yup... Its just like Merit based pay for teachers.... What do you do for the poor teacher that just gets several classes full of dumbasses?



Yes healthcare in America needs work... This is not the solution however.

Oh yeah, I was thinking that before I opened the thread.
My solution - bring back shame. Make it shameful to loaf around like a Biggest Loser contestant and balloon up like that. Society or culture could drive big changes in health, not government.

I'd first look and see which countries have done that, and how well it works there.

The impetus behind it is good (and maybe this method is good too, dunno) and that is to try and focus on outcomes.

That's the first thing that popped into my head. Just because a doctor or hospital has "worse" results doesn't mean that's bad care.

Using this "wellness metrics" concept, what's my incentive to take care of a complicated case? Why not just punt them all to the local university center? Make up some garbage about a "higher level of care" not available in the community setting. After all, I'd rather take the otherwise healthy patients with stable disease and perform elective surgeries on them (i.e. 45 year-old healthy male with a history of diverticulitis, now controlled, who wants a sigmoid colectomy to prevent future recurrences), and send the acutely ill ones (e.g. 65-going-on-85 year-old patient with emphysema, poorly-controlled diabetes, morbid obesity, a couple of heart attacks, with three previous intra-abdominal surgeries, now with a diverticular abscess and an acute abdomen) to the tertiary care medical center.

Take care of healthy people (you know, the people who would do well even if they were taken care of by a chimpanzee) and your "wellness metrics" will be through the roof.

Like in gymnastics, diving or figure skating, it's not just about how well you do it, there's also some accounting for degree of difficulty reflected in your final score.

There was a vascular/general surgeon I knew in Texas who had a pretty high mortality rate. He was a fine surgeon, even great, but he had some of the sickest MFers you ever saw that he was taking care of. Saw him pull a rabbit out of a hat and save people who you would never guess would live long enough to finish a cup of coffee

He is a Porsche guy too. One of the OR nurses had a son who was dying of cancer, 14 yo kid. She is one of the sweetest ladies I ever met, and her son was every bit as nice as she was. We did this little ceremony where we planted a tree that you could see from the OR lounge. Afterwards, Rich let the kid drive his 911 around the hospital grounds a few times, makes me cry a little just typing about it.

There is a "Wellness Practice" provision in Medicare now. It has been there for at least 5 years, so it's not new. Under this provision, a Doc can set up a Wellness practice consisting of current medicare recipients, and as long as he (or a PA working for him/her) sees each of his patients monthly, he will get medicare reimbursement for keeping them healthy. He can also get normal medicare reimbursement for treatment when they are ill.
As a E D of Senior Care communities (Assisted Living, Alzheimer's Care, and Independent Living) I can tell you that this practice is a very good thing for most seniors, vs the normal method - stay home until you are sick, then see your Primary, or maybe go to the ER for something that would possibly have been caught at an earlier stage.
You can be in this program and still retain a separate PCP if you choose.

These Doctors and their PA's actually make house calls, many have given up their office practice, and the ones that I have contact with are loving practicing medicine again.

From each according to his ability, to each according to his needs...

I'm not sure how that system would work when a patient would be cared for by many different specialists. How would a rheumatologist be able to manage the wellness of his patients, who have all sorts of issues outside the rheumatologist's purview? Ditto a surgeon who only sees a patient for specific issues, etc. Maybe this system could work for a general practioner.

I'm not sure how you deal with the perverse incentives Noah mentioned, or how you measure wellness in a practical manner.