"outcomes-based reimbursement works only in a limited sector of healthcare" http://t.co/XFFymLHA8i
— Dr. Luis Ramos Neira (@lramosneira) April 29, 2014
Dr. Luis Ramos is a very professional dedicated to networking. He defines himself as a quali - epidemiologist. Well, his tweet brings us to a post in The Health Care Blog, signed by a Swedish family physician, Dr. Hans Duvefelt, who works in a town in Maine, on the east coast of the United States. It’s a short clear post, from which I have extracted the main ideas.
We're hearing now that doctors should be paid in accordance with the clinical results of their work and of course we’re not talking about parameters such as controlling blood pressure or glycaemia, but about death, strokes, heart attacks, amputations, hospital infections, etc. But the question is: How can we measure the patients degree of involvement now that there’s so much talk about them? Should the doctor charge less if his diabetes patient is not doing well despite his good work? Wouldn’t this model lead us to the selection of patients?
If you read the post, don’t miss the comparisons that Dr. Duvefelt makes with other sectors: Anyone thought that fire-fighters should charge less if the fire completely destroys a house? Or that an inspector shall not charge if the crime he’s investigating remains unsolved? Or that a military shall take a pay cut when he loses a battle? And he continues: “now imagine that, despite being against this, when push comes to shove, we’ve got to measure health outcomes. When a patient needs rehospitalisation, how will we determine which one of the various service providers went wrong? What if the relapse of a chronic bronchitis patient is not due to any error of any doctor or nurse but to a cold air intake. What kind of bureaucracy should be put in place to measure all this? "
With so many ethical and professional doubts about the implementation of a professionals’ pay based on clinical outcomes, Dr. Duvefelt proposes to focus on the basics: an honest wage for an honest job. Mayo Clinic and Kaiser Permanente are doing it this way with good outcomes.
Jordi Varela
Editor
We're hearing now that doctors should be paid in accordance with the clinical results of their work and of course we’re not talking about parameters such as controlling blood pressure or glycaemia, but about death, strokes, heart attacks, amputations, hospital infections, etc. But the question is: How can we measure the patients degree of involvement now that there’s so much talk about them? Should the doctor charge less if his diabetes patient is not doing well despite his good work? Wouldn’t this model lead us to the selection of patients?
If you read the post, don’t miss the comparisons that Dr. Duvefelt makes with other sectors: Anyone thought that fire-fighters should charge less if the fire completely destroys a house? Or that an inspector shall not charge if the crime he’s investigating remains unsolved? Or that a military shall take a pay cut when he loses a battle? And he continues: “now imagine that, despite being against this, when push comes to shove, we’ve got to measure health outcomes. When a patient needs rehospitalisation, how will we determine which one of the various service providers went wrong? What if the relapse of a chronic bronchitis patient is not due to any error of any doctor or nurse but to a cold air intake. What kind of bureaucracy should be put in place to measure all this? "
With so many ethical and professional doubts about the implementation of a professionals’ pay based on clinical outcomes, Dr. Duvefelt proposes to focus on the basics: an honest wage for an honest job. Mayo Clinic and Kaiser Permanente are doing it this way with good outcomes.
Jordi Varela
Editor
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