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New Physician Oath: First, Reward Quality Care

Elyas Bakhtiari, for HealthLeaders Media, December 3, 2009

It is a callous and un-Hippocratic way of looking at medical care, but as Jauhar notes, "it is naïve to think that money cannot or should not be used to influence [physician] decisions."

President Obama has expressed a desire to change physician financial incentives—he was widely criticized when tried to explain the system with an example of a physician performing a tonsillectomy for financial reasons—but reform legislation has yet to address the issue head on.

Physician leaders don't have to wait for Washington to act. Many of the pay-for-performance programs like those studied by the UCLA researchers are happening at a more local level and being driven by private payers.

And many of the most direct financial incentives can be changed at the group level. Quite a few physician practices still pool revenues and allocate compensation to physicians based on elaborate formulas that are almost entirely driven by productivity (as measured by RVUs). Why not tweak the formulas to emphasize quality or patient experience?

Some already do this, but what's missing is a widespread change in practice compensation structures. Savvy leaders are making changes now because they perceive a top-down change coming relatively soon, and they want to be well-positioned in a new reimbursement system.

But finances aside, if its guiding principle really is to "first, do no harm," why would a practice still reward physicians for the quantity, rather than quality, of their care?


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Elyas Bakhtiari is a freelance editor for HealthLeaders Media.

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