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Why Docs are 'Constantly Encouraged to Do Bad'

Joe Cantlupe, for HealthLeaders Media, August 22, 2013

De Brantes also referred to expenses for treatment of various diseases or illnesses detailed in Dartmouth Atlas reports. He noted that Dartmouth Atlas found more than a two-fold difference in Medicare spending on patient care from one region of the country to another, during 20 years of studies.

The significant variations in costs of "medical episodes of care has led to well-documented waste in resources and harm to patients and oddly enough, most variability occurs with medical episodes that require the most pressing attention," de Brantes reports. To reduce variations of treatment, De Brantes says health care systems should create a "list of targets" that focus on issues such as "episode costs, price per unit, quantity and mix of services" and potential interventions.

Physician Isolation
Oddly enough, de Brantes says, while physicians are impacted by financial incentives within organizations, they are often isolated in the process.

"That's often the case for clinicians employed by large medical groups or health systems," de Brantes reports. "External payment incentives are filtered by the organization which decides how to convert those incentives into salaries and other payments for clinicians. This filtering action might have a very different impact on a clinician's motivation than the original, unfiltered incentive."

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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.