Boost in Docs’ Incomes Comes From More Procedures, Not More Patients

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High-income doctors make more money by ordering more procedures for each patient rather than by seeing more patients, which may not be the best thing for patients, a new study suggests.

The findings from the analysis of 2012 Medicare data were “very surprising,” according to the authors of the research letter published Dec. 8 in the journal JAMA Internal Medicine.

“Medicare spending is the biggest factor crowding out investment in all other social priorities,” first author Dr. Jonathan Bergman, an assistant professor of urology and family medicine at the University of California, Los Angeles, said in a university news release. He’s also a urologist and bioethicist at the Veterans’ Health Administration-Greater Los Angeles.

“With clinicians making more not by seeing more unique patients, but by providing more services per person, additional research needs to be done to determine if these additional services are contributing to improved quality of care,” he added.

“These findings suggest that the current health care reimbursement model — fee-for-service — may not be creating the correct incentives for clinicians to keep their patients healthy. Fee-for-service may not be the most reasonable way to reimburse physicians,” Bergman suggested.

“Perhaps it would make more sense to reimburse clinicians for providing high-quality care, or for treating more patients. There probably shouldn’t be such wide variation in services for patients being treated for the same conditions.”

Additional research is needed to find out if patients who undergo more procedures have better outcomes than those who have fewer, Bergman said.

He and his colleagues plan to examine alternatives to the current fee-for-service payment approach.

“The goals of payment reform are currently unrealized, as evidenced in these data. Physicians take an oath to care for patients using ‘appropriate means and appropriate ends,’ focusing on what is best for the patient, and this centuries-old oath still resonates with graduates of medical school classes,” according to the research letter.

“Clinicians can lead the movement toward a high-value, patient-centered care. We are uniquely empowered to ensure that all individuals access the procedures they need, and are not exposed to those they don’t,” the authors concluded.

More information

The U.S. Agency for Healthcare Research and Quality outlines questions you should ask your doctor.

Source: HealthDay

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