Monday, 16 February 2015

Adding value to doctor's remuneration

NEJM devotes an editorial and a couple of articles (they can be downloaded for free) to the new model for doctor’s remuneration by Medicare. This is a matter specific to the Americans, you’ll say. Therefore, it wasn’t necessary to choose it as this tweet to discuss. Although I have to admit that in these aspects of innovations in cataloguing and financing models, sometimes the Americans are right, as was in the case of DRG, then we all rush to import them into our systems.

"Affordable Care Act" (the health system reform law also known as Obamacare) generated, with surprising consensus between Republicans and Democrats, the mandate to create a new doctor payment model based on high value clinical practice, understood as those that provide higher quality at lower costs. But, according to these articles referred to by the NEJM’s tweet, things aren’t working out so well. Note a few statements that I’ve underlined:
  • Science for measuring the doctor’s clinical activity is under-developed.
  • "Physician Quality Reporting System" is the system on which the assessment is based. It comprises more than 200 measures and is overly cumbersome.
  • After all, the bonuses go up to + 2% of the total of doctors’ remuneration in the awards’ section and on the other side the penalties can go down to -1%.
  • Many doctors prefer to assume a possible penalty and "pass" for compliance with the 200 quality measures.

For now, it doesn’t seem that the Obamacare is advancing too much in its intention to add value to medical compensation. However, we’ll follow it, albeit from a distance.

Jordi Varela


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