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Why Docs are 'Constantly Encouraged to Do Bad'

Joe Cantlupe, for HealthLeaders Media, August 22, 2013

The motivation to properly care for patients "has been sapped by poorly designed incentives," one economist says. Pay-for-performance models, capitation, and bundled payments "often fall short of their goals and must be re-examined."

As healthcare organizations evaluate payment models, the role of physicians is central to where hospitals and health systems want to go and how they will improve the quality and efficiency of care.

But can providers effectively stop doctors from performing too many needless tests? Can they engage with physicians and give them proper rewards? Can patient care be improved, with a proper cost structure for all types of care and disease states? Will the move from fee-for-service to value-based care work?

Will physicians be "motivated" to achieve healthcare's goals, for population health?

"We're continuing to try to come up with some mix that is going to push the doc in this direction or that," says Francois de Brantes, an economist and executive director of the Health Care Incentives Improvement Institute. "You know the tension with docs has been, 'I'm not paid to do X, I'm paid to do Y,'' de Brantes says. "So we're moving from fee-for-service. OK, what's next? We aren't totally focused, yet people say everything is cool, and everything is going to be great."

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2 comments on "Why Docs are 'Constantly Encouraged to Do Bad'"


John Jaffe MD (8/23/2013 at 12:46 AM)
Please show me the evidence that physicians working under fee for service arrangments "order too many tests" (which usually they don't profit from), "do too many procedures", etc. It's possible that physicians working under capitation arrangements do too few! Thank you.

Jeff Angel (8/22/2013 at 2:39 PM)
Article is full of generalized, over-used debate points with no real ideas on how to improve medicine or no validity to the fact that even if waste is cut to zero, which technically cannot happen in a multi-variable system, there are not enough resources for the amount of pathology going forward. Blaming doctors is a good sound byte, but if docs worked for minimum wage there still is a deficit. To make like you are solving " medicine" with getting rid of bad behavior/bad docs is intellectually naive or dishonest. Demographics will require rationing....so call it out...we need to ration, and quit bashing docs New article in JBJS.....Total knee replacements save society 12billion dollars a year....MPHs and brainwashed media and politicians will reject that study, because of bias...please become scientific in your reporting to help us all.