Don’t blame fee-for-ser­vice for all of health­care’s ills

Modern Healthcare - - COMMENT -

Re­gard­ing the June 30 ed­i­to­rial (“In­sur­ing against the fu­ture,” p. 24) this ar­ti­cle is an­other at­tempt to sell Amer­i­cans on the no­tion that fee-forser­vice is the cause of our health­care spend­ing woes and must be abol­ished if we hope to get spend­ing un­der con­trol. As in other such ar­ti­cles, this as­ser­tion is jus­ti­fied by stat­ing “sys­tem lead­ers are stuck with a re­im­burse­ment sys­tem that still re­wards vol­ume,” as if high vol­ume of work and high qual­ity can­not mu­tu­ally ex­ist. And go­ing fur­ther to state that the “mar­gins at hos­pi­tals per­form­ing one com­pli­cated surgery rose from $17,000 to $56,000 af­ter things went wrong” bla­tantly sug­gests that surgeons might ac­tu­ally be de­lib­er­ately caus­ing com­pli­ca­tions so they could be paid more.

Fee-for-ser­vice in­cen­tivizes spe­cial­ists to work as hard as nec­es­sary to keep up with fluc­tu­at­ing vol­ume de­mands in their prac­tices, keeps physi­cians ac­count­able to pa­tients, not bu­reau­crats, and en­cour­ages ad­her­ence to the eth­i­cal prin­ci­ples upon which med­i­cal prac­tice is based—keep­ing what is best for pa­tients the over­rid­ing ba­sis for all med­i­cal de­ci­sion­mak­ing.

Elim­i­na­tion of fee-for-ser­vice for spe­cial­ists will cre­ate the ex­act situa- tion we see in the VA health sys­tem: pa­tients wait­ing in­or­di­nate amounts of time for care and the aw­ful con­se­quences that re­sult for the pa­tients and their fam­i­lies. Dr. Thomas M. Flake Jr. South­field, Mich.

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