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Why Docs are 'Constantly Encouraged to Do Bad'

Joe Cantlupe, for HealthLeaders Media, August 22, 2013

In a recent Robert Wood Johnson Foundation report and Health Affairs blog post, de Brantes argues that as healthcare moves toward reform, it still must construct payment models that truly reflect variations of care, and incentives in provider contracts. In addition, reforms must overcome a myriad of issues ranging from innate isolation among physicians involving fiscal matters in health care systems, to dealing with improper self-referrals among physicians, he says.

Inevitably, the "carrot-and-stick" approach for physicians, whether pay-for-performance, capitation, wellness bonuses, bundled payments or consumer-directed health plans, often fall short of their goals and must be re-examined, de Brantes writes.

Poorly constructed financial models inevitably undercut physician motivation and result in undesired patient outcomes. Healthcare, inevitably, should look toward the private-sector business world to improve its efficiencies and outcomes, de Brantes says.

"Undeniably for healthcare providers, the motivation to properly care for patients and 'do no harm' significantly impacts the treatment decision-making process," de Brantes writes. "However, this motivation has been sapped by poorly designed incentives. The challenge we face in healthcare is to figure out how to reverse the incentives that currently encourage doctors, nurses, and others to make inefficient and potentially harmful health care choices."

"Said plainly, it's tough to be good when you're constantly encouraged to be bad," de Brantes says.

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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.