Good article; thanks John. Don't know how that translates to public policy.
Indeed, across the board, costs are going up. And between the millstones of fee-for-service and pressure from insurers to curb all the extra billing, family doctors are being ground into paste. "We've made it systematically as unpleasant to be a PCP as it is to be a primary-school teacher," says Gene Lindsey, president of Atrius Health, a nonprofit alliance of medical providers in Massachusetts. "We're real adept at that."
But there are ways to fix what ails the docs — and repair the health-care system in the process. In the rolling hills of central Pennsylvania, the Geisinger Health System is trying something different. The 726 physicians and 257 residents and fellows who work there don't do piecework. They are paid a salary — benchmarked against the national average — plus potential bonuses based on how well their patients do under their care. One result is that Geisinger is able to hang on to its PCPs while other hospitals are losing theirs. Another is that Geisinger makes money, and, oh yes, the patients get well.
(Read "Can New Doctors Be Harmful to Your Health?")
In his Sept. 9 speech to Congress, President Obama singled out Geisinger and Utah's Intermountain Healthcare as examples of organizations that are learning to do things right. He could have cited others too: the Cleveland Clinic, the Mayo Clinic, Kaiser Permanente. What these providers have in common are the creative ways they're doing away with fee-for-service and replacing it with an imaginative mix of systems that cost less, keep patients healthier and make doctors happier. "We need a transition to rewarding the actual value of care," says Dr. Elliott Fisher, director of population health and policy at the Dartmouth Institute. "For now, our payment system is getting in the way."
(See the Cleveland Clinic's smarter approach to health care.) |
