For decades, the American Medical Association has violently opposed any system other than fee-for-service medicine, but virtually any health reform that works is likely to require changes to physician payment models. That the system will change, at this point, is basically a done deal; the question is what those changes will be. And that all turns on what policymakers feel will offer the most appropriate incentives.
One option that's gotten a lot of attention over the last week is the clinic model, with President Obama giving it a conspicuous nod with his visit to the Cleveland Clinic. That model, which relies on keeping physicians on salary, seems to produce high-quality results at lower prices than comparable institutions using independent physicians for care.
It's not just giants like the Cleveland Clinic that have benefited from this model, however. Another example was written about in the New York Times, which profiled Cooperstown, N.Y.-based Bassett Healthcare, a 180-bed hospital which employs all of the 260 physicians who work there.
Medical costs there are lower than 90 percent of the state's facilities, and care quality ranks among the top 10 percent in the nation, according to surveys. The hospital's leaders say they offer salaries competitive with money earned in a fee-for-service setting. This may be because physicians have little incentive to order needless tests or procedures, and plenty of opportunity to coordinate care and share best-practice guidelines.
Also, as is common at clinics like Mayo and Cleveland, patients find that doctors remain in closer touch than when they're seen by independent practitioners. The problem, though, as we've mentioned in prior FierceHealthcare items, is that it's very hard to get physicians to give up independent practice. Seems that the DC policy wonks should function on that one piece of the problem--how to make salaried physicians feel as empowered as possible--and we may have a paradigm here, folks!
To find out more about Bassett:
- read this New York Times piece
Related Article:
Obama administration points to Cleveland Clinic as reform model