Your premise, switching from a Medicare fee-for-service payment model, does not take into account multiple variables physicians must consider. Putting financial burdens on doctors for better results ignores social factors, including personal compliance.
For whatever counseling and medication I might prescribe, how do I make a patient take their medication appropriately, exercise routinely or stop smoking or using alcohol? I'm a doctor, not a baby sitter. There is also a chance that should I neglect to order a test, I'll get sued by an avaricious malpractice lawyer.
There are many factors you don't mention, including tort reform, Medicare fraud and end-of life discussions, which when dealt with might enhance healthcare for seniors.
Gene Dorio, MD
As "managed care" began to change the practice of medicine, I was part of a team of lawyers that gave talks explaining it to other lawyers. In my introduction to the talks, I used the preface to George Bernard Shaw's play "The Doctor's Dilemma."
Shaw noted that he would have been happy to pay his doctor an annual fee for keeping him healthy, but he reasoned that if he became sick, it was the doctor's responsibility to treat him without further charges. This is the basic idea behind HMOs: Providers keep more of the upfront money the less care they have to provide, so there is an incentive to keep people healthier.
Shaw also noted that the more egregious the insult to his body by the surgeon, the higher the fee he had to pay, which seemed unfair to him. Why should an appendectomy cost more than removal of a wart?
Robert Von Bargen
I find your editorial condemning fee-for-service simplistic. In an attempt to control runaway costs of healthcare, physician fees have been decreased considerably since the Balanced Budget Act of 1997 passed. The fee for my first colonoscopy in 1971 is the same as now, but the dollar now is worth much less.
The reforms physicians are in desperate need of involve controlling the exorbitant prices of drugs, medical equipment and hospital stays. Without these cost controls, any attempt at efficiency and savings would result in care delayed or denied. Any other attempt at cost control, including accountable care organizations, are only smoke and mirrors.
Let committed physicians be physicians.
Jerome P. Helman, MD
Medicare originally did not take into account that science and technology would save lives and extend them. My grandfather had one cancer and died from it, a financial success to Medicare. Now, Americans surviving multiple cancers and heart surgeries end up taking tons of medications into their 80s and 90s. They often end up in nursing homes for years. The resulting cost of our "medical success" has become quite prohibitive.
To place reform of this fiscal mess on the shoulders of physicians is disingenuous. Who is responsible for obesity? Yes, there are quality gains to be had, but that is the essence of medicine and how we got to this point.
Doctors are already accountable to the legal system, state licensing and peer review. When doctors realize that they are being punished financially for their patients' problems, they will quit.
Edward Young, MD