Better ways to pay for medical care?

From Massachusetts’ plans to revamp medical spending to the Republican controlled U.S. House plans to change Medicare spending, there are efforts to move from a health care system that pays for services to one that pays for quality services.  To learn more about practical ways to improve health care delivery by changing incentives, listen to Dr. Mark Fendrick, Co-Director of the University of Michigan Center for Value-Based Insurance Design, talk about how value-based insurance can incentivize patients to seek out better health care at lower cost on Getting Better Health Care.

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What’s right and what’s wrong with the U.S. health care system?

What’s right and what’s wrong with the U.S. health care system? Does it need a major overhaul or a few tweaks?

In a two part episode, I discuss the cost of the U.S. health care system with Dr. Robert Berenson, a health care policy expert who has served as a practicing physician, the manager of a large health plan and in senior government positions, including being in charge of Medicare payment policy and private health plan contracting in the Centers for Medicare and Medicaid Services.

Dr. Berenson describes how incentives need to change to get control of our medical costs.  You can hear both of these episodes and others on my online podcast radio program, Getting Better Health Care.

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More doctors don’t equal happy patients, more empathetic doctors do

Researchers from the Dartmouth Institute for Health Policy and Clinical Practice and the Centers for Medicare and Medicaid Services have found that beneficiaries of Medicare who live in areas with a “larger supply of doctors” are not any more likely to be satisfied with the physician care they receive or the time they spend with their doctors than Medicare recipients who live in regions with smaller pools of physicians. Additionally, the study “found no significant differences in access to specialists or availability of tests.

This isn’t surprising.  At DrScore, we’ve found that seeing a caring, friendly doctor is the critical factor in patient satisfaction.  Having more doctors won’t make patients happier, but having more empathetic doctors who show how much they care about their patients does.

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The economy is bad, but doctors still doing well

The monthly newsletter came from my medical specialty society.  There was an article on how much doctors are being paid, pointing out that in 2009 doctors in my specialty experienced an increase in average income of between 7-12 percent, though specialists in general saw a decrease of about 4 percent.

In a down economy with a lot of people hurting and roughly 10 percent unemployment, doctors have been relatively spared from financial pain. As the deficit commission looks into ways to cut costs, reducing payments to doctors will be considered.  I suspect physician organizations will aggressively fight such cuts, pointing out that potential cuts in Medicare would hurt patients.

I don’t want to see patients hurt, but the patriotic side of me says that we doctors shouldn’t be completely spared from the effects of a down economy that is causing our patients to suffer.

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Who decides how much Medicare pays?

The Wall Street Journal (10/27, A1, Mathews, McGinty) reported a committee of doctors called the Relative Value Scale Update Committee (RUC) decides how much Medicare pays for various medical procedures. This committee wields considerable power over how Medicare dollars are spent.

It is good to have doctors deciding this?  Who would be better?  Government regulators?  In private insurance plans, the insurer and the doctor contract for what those prices should be.

We now have a health care system that largely removes from patients the direct responsibility of paying for care.  So if patients aren’t going to decide how much they will pay, it’s left to someone else — either the insurer or the government.  It may seem that leaving this in the hands of doctors may not be a great idea, but the RUC can’t pay doctors whatever it wants. It just sets the relative amount that one procedure gets paid vs. another.  It’s a zero-sum game, so that if one procedure is paid more, another is paid less.

So while the RUC is controlled by physicians, those physicians don’t change Medicare’s overall costs.

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Where is the Institute for Healthcare Improvement (IHI) headed?

With founder Don Berwick leaving to guide the Centers for Medicare and Medicaid Services (CMS), IHI is now headed by former No. 2, Maureen Bisognano. The IHI has been a leader in changes to the U.S. health care system,. Bisognano describes the IHI mission as “will, ideas and execution.”

To learn more about where our health care system is headed, read this interview. It looks like we’re headed toward a health care system that is even more patient-centered, something that is most welcome at DrScore.com.

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Improving access to preventive care services

One way that recent health care reform legislation is supposed to help improve care while lowering costs is by encouraging more preventive care services to be offered. The Center for Medicare & Medicaid Services (CMS) announced new preventive health benefits created under the Affordable Care Act for seniors and persons with disabilities covered by Medicare.

Click here to learn more about these benefits.

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