Should Doctors Get Paid Less If They Don’t Keep Patients Healthy?

One important piece of health policy where Republicans and Democrats agree

At the moment, the political parties seem to disagree on almost everything healthcare-related. There’s one major piece of health policy, though, on which they do agree: Both want to change how Medicare, the country’s largest insurer, pays doctors.

Lawmakers as conservative as Utah Republican Sen. Orrin Hatch and as liberal as Michigan Democrat Rep. Sandy Levin are meeting to consider a proposal that would change the way physicians get paid. Rather than the current system, which pays doctors for every test or procedure they do, the new method would pay physicians based on whether they help patients get or stay healthy. 

Under the proposed system, health professionals billing Medicare would be scored on several measures, including whether they use electronic health records and if they try to keep patients healthy after they leave the office. Doctors with the highest aggregate score would get a bonus payment; those with the lowest scores would see their payments slashed. The message the federal government would be trying to get across is clear: Improve your care or pay the price.

The catch? Congress might agree to change payments, but doctors may not care to adopt them. As Robert Berenson, an internist who has held numerous Medicare policy positions in the government, pointed out last month, less than 30 percent of Medicare doctors have submitted data in the federal government’s current effort to get doctors to track quality measures. The low participation rate signals that something is amiss.

Take a look at Houston, where Medicare patients are a big business. Medicare spent $11,567 on each enrollee in the Houston area in 2010, according to the Dartmouth Atlas, putting it well ahead of the national average of $9,584.

It’s also the city where John McCarthy has practiced hematology for nearly three decades. Or, as he is known to me, Uncle John. He was the first person I reached out to on this topic because he always loves a good, heated health care debate.

"Quality and quantity metrics are business speak, this pseudonymous lingo that is being used to talk about rationing. Some of it is good, but a lot of it is hocus pocus," he told me almost immediately when I called him. Doctors, for the most part, he argues, have always used the best evidence for treating their patients.

“We take vital signs every time a patient comes in to our office. Now we have to report them to the government. But in 90 percent of my patients, their blood pressure issues are managed by other doctors, such as their primary care physician or a cardiologist. But we still have to record it, even though it doesn’t measure the quality of my assessment of the patients’ blood disorder. So we spend a little time on every patient checking off boxes that are simply misused or misunderstood by the government,” McCarthy said.

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