Change Doctors' Pay

[lostintime]

Interesting Article

 

http://www.healthzone.ca/health/newsfeatures/healthcaresystem/article/795439--one-way-to-lower-health-costs-change-doctors-pay?bn=1

 

The province should overhaul the way doctors are paid so that the profession gets a smaller chunk of healthcare funding, says a coalition of healthcare providers.

 

The bold recommendation is contained in a report, to be released Thursday, that calls for major changes to Ontario’s health system aimed at saving billions of taxpayer dollars.

 

The report, titled Bending the Cost Curve, was produced by the Ontario Hospital Association, the Ontario Association of Community Care Access Centres and the Ontario Federation of Community Mental Health and Addiction Programs.

 

An advance copy obtained by the Star notes that Ontario spends disproportionately more on physicians than other provinces. Last year, physician expenditure in Ontario was $566 per capita, compared with $675 per capita in other provinces. Ontario would save $2.2 billion annually if its spending on doctors was more in line with that of other provinces.

 

The report urges the province to take more of a “business-case approach” to allotting scarce health-care dollars. Funding decisions should be based on evidence that shows good return on investment and better quality of patient care.

 

The report calls on the province to amend the Public Hospitals Act and do away with hospital privileges for doctors, instead putting them on contracts that set out performance goals. Doctors would be reimbursed, for example, for seeing a specified number of patients in a certain time frame. Their pay would also be linked to patient outcomes.

 

Many physicians, including those who work in hospitals and have what is known as hospital privileges, get a large share of their remuneration from fee-for-service billings to OHIP.

 

The report states that about $800 million annually could be saved by better managing the care received by the 1 per cent of the population who account for a whopping 49 per cent of hospital and homecare costs. These tend to be very young and very old people who suffer from chronic conditions.

 

Other savings could be found by better managing chronic conditions, improving home care, increasing at-home palliative care and providing more community mental health and addiction services.

[The Law]

Wow, because clearly, patient outcomes are under a physician's control and rushing patients in and out of the clinic is the best way to practice medicine. Dear god these bureaucrats know nothing.

[Jochi1543]

 

The report calls on the province to amend the Public Hospitals Act and do away with hospital privileges for doctors, instead putting them on contracts that set out performance goals. Doctors would be reimbursed, for example, for seeing a specified number of patients in a certain time frame. Their pay would also be linked to patient outcomes.

 

Dumbest piece of **** I've ever heard.

[dmleo]

Dumbest piece of **** I've ever heard.

 

agreed completely

 

how can anyone draw a clear line on what is considered a good outcome

or bad for a patient? for instance, if a doctor tried his best and did everything

he possibly could have done in his power, yet the patient died so does

this mean the doctor who worked his *** for his patient doesnt get paid

simply because the "outcome of the patient" is bad? if this was how doctors were paid, no body would ever go into surgery or internal med because they'd have to deal with patients who dont improve very easily so its not very lucrative if you get paid by how much you can make them better right?

[Dongzhuo]

coalition of healthcare providers.....lol, they just couldn't stand the sight of MD's in their benzes

[mrnursing]

First it's the pharmacists... now the physicians?

[estairella]

I for one think this would be a great change.

 

I eagerly look forward to the day when I can look someone with a chronic illness in the eye and say "Sorry, I would take you but based on your multiple comorbidities, this would be unacceptable for me attaining my performance targets. Yeah.. you know those things you voted for in the last election?"

 

Either the performance system will work great, or we'll have a lot of chronically sick people die... which I guess would still be considered a win in performance stats in the long run!

[UTPEOPLE]

coalition of healthcare providers.....lol, they just couldn't stand the sight of MD's in their benzes

 

lol... let the coalition be jealous. The CMA has FAR too much political clout for stuff like this to ever go through... they are like the oil companies of med...seriously, if doctors were paid based on performance targets, we wont ever have experimental treatments again... ever

[ploughboy]

 

An advance copy obtained by the Star notes that Ontario spends disproportionately more on physicians than other provinces. Last year, physician expenditure in Ontario was $566 per capita, compared with $675 per capita in other provinces.

 

It's late, I'm tired and maybe missing something blindingly obvious, but aren't those two sentences contradictory?

[MedDream]

Dumbest piece of **** I've ever heard.

 

Agreed. Wow.

[estairella]

It's late, I'm tired and maybe missing something blindingly obvious, but aren't those two sentences contradictory?

 

Correct quote

An advance copy obtained by the Star notes that Ontario spends disproportionately more on physicians than other provinces. Last year, physician expenditure in Ontario was $842 per capita, compared with $675 per capita in other provinces.

[leviathan]

I for one think this would be a great change.

 

I eagerly look forward to the day when I can look someone with a chronic illness in the eye and say "Sorry, I would take you but based on your multiple comorbidities, this would be unacceptable for me attaining my performance targets. Yeah.. you know those things you voted for in the last election?"

 

Either the performance system will work great, or we'll have a lot of chronically sick people die... which I guess would still be considered a win in performance stats in the long run!

That already happens today. There's not enough money provided to pay for the extra time you need with complicated patients, so family physicians populate their practice with young healthy patients instead.

 

 

It's late, I'm tired and maybe missing something blindingly obvious, but aren't those two sentences contradictory?

Yeah it didn't make sense to me either....or maybe it's me being tired too.

[Ollie]

If Pay-for-Performance is ever introduced, I will seriously consider leaving medicine. It is a terrible, horrible, no good, very bad idea. As if family practice isn't hard enough. I don't want to have to worry about big brother looking over my shoulder to make sure all my A1Cs are at target. It encourages cookbook medicine and blind adherence to guidelines rather than physician-patient shared decision making. But I bet the pharmaceutical companies would love it!

[leviathan]

If Pay-for-Performance is ever introduced, I will seriously consider leaving medicine. It is a terrible, horrible, no good, very bad idea. As if family practice isn't hard enough. I don't want to have to worry about big brother looking over my shoulder to make sure all my A1Cs are at target. It encourages cookbook medicine and blind adherence to guidelines rather than physician-patient shared decision making. But I bet the pharmaceutical companies would love it!

 

Well hopefully the ontario med association can be involved in designing any new system of billing so that it takes into account all the cons that have been mentioned.

[AdamP]

Just read Dan Pink's Drive. Very prescient.

 

It won't blow your mind, just confirm some things you may have been suspecting..such as why granting doctors (well, all employees) with autonomy will make them perform better and why reward/punishment systems based on money do NOT pan out in the real world.

 

dude has a really amazing ted talk too, lol I used some of the themes in one of my essays if I remember correctly.

 

http://blog.ted.com/2009/08/the_surprising.php

[Byrne]

Dumbest piece of **** I've ever heard.

 

Agreed

 

10 char

[Dongzhuo]

I half expected someone to post saying doctors should be paid lower so that only people who truly wanted to do medicine and not care about money would go into the profession. darn

[UTPEOPLE]

I half expected someone to post saying doctors should be paid lower so that only people who truly wanted to do medicine and not care about money would go into the profession. darn

 

well some, like optho... definitely deserve to get their wages cut, if it happens. but if anything, we need to raise family physician wages so that they reach parity with other specialties

[guitarded27]

Wait, so they want to get rid of the problems inherent in the fee-for-service payment method by....offering a contract-systems that rewards doctors per service...?

 

[UTPEOPLE]

Wait, so they want to get rid of the problems inherent in the fee-for-service payment method by....offering a contract-systems that rewards doctors per service...?

 

 

fee per performance actually, which is arguably worse ethically....

[NLengr]

Don't worry people. This is how the Soviet Union used to set up production and worker output. Some bureaucrat who has no idea about what they are managing sets arbitrary goals without consideration for the actual situation. And, correct me if I'm wrong, but the USSR is doing just fine.

 

What? They broke up? Terrible levels of production? Widespread alcoholism? Worker revolt? 20+ years behind the West in performance and technology? Well....maybe we shouldn't be trying to copy them.

 

Seriously though, if you make physicians have pay to performance, all the chronically ill and old people are going to be without doctors. Pediatrics will be over loaded.

[apache]

I think family med should take up a greater percentage of residency spots with cuts in spots to specialty positions. If possible, we could make FM residency a little longer and more comprehensive, similar to peds, perhaps 3-4 years residency with a proportionate pay increase. Rads, optho, and derm need some serious slashing in their fee schedules.

 

 

well some, like optho... definitely deserve to get their wages cut, if it happens. but if anything, we need to raise family physician wages so that they reach parity with other specialties

[runningdoc]

Now the question is, do we come up with a new rating for successful treatment of a patient:

 

5 points for a full recovery

4 points for a recovery with mild complications

3 points for a recovery with significant complications

2 points for not killing the patient but leaving them significantly compromised

1 point for killing the patient when they had a life threatening illness

0 points for killing the patient when they had a non-life threatening illness

 

Doctors get paid based on the points system. $100 for each point.

 

Sounds like a brilliant system. If I get into medicine, I plan on taking only people with colds as patients. I'll be rich!!!!

 

Politicians are some of the dumbest people on the planet, yet they end up making the decisions when it comes to stuff like this. It is really, really, really, really, really amazing that the government sees fit to wage war with health care workers on a constant basis (between nurse cuts, other hospital staff cuts, the pharmacists, and while this isn't an immediate concern, physicians) meanwhile they continue to hand out boatloads of money to every other public sector worker.

[UTPEOPLE]

Now the question is, do we come up with a new rating for successful treatment of a patient:

 

5 points for a full recovery

4 points for a recovery with mild complications

3 points for a recovery with significant complications

2 points for not killing the patient but leaving them significantly compromised

1 point for killing the patient when they had a life threatening illness

0 points for killing the patient when they had a non-life threatening illness

 

Doctors get paid based on the points system. $100 for each point.

 

Sounds like a brilliant system. If I get into medicine, I plan on taking only people with colds as patients. I'll be rich!!!!

 

Politicians are some of the dumbest people on the planet, yet they end up making the decisions when it comes to stuff like this. It is really, really, really, really, really amazing that the government sees fit to wage war with health care workers on a constant basis (between nurse cuts, other hospital staff cuts, the pharmacists, and while this isn't an immediate concern, physicians) meanwhile they continue to hand out boatloads of money to every other public sector worker.

 

and -1 points if you kill a patient without a life-threatening injury and then try to cover it up.

 

At least family physicians would be a lot more lucrative under this system

[NLengr]

I think family med should take up a greater percentage of residency spots with cuts in spots to specialty positions. If possible, we could make FM residency a little longer and more comprehensive, similar to peds, perhaps 3-4 years residency with a proportionate pay increase. Rads, optho, and derm need some serious slashing in their fee schedules.

 

We aren't exactly overloaded with every kind of specialist either. In fact, most of specialist field don't have enough people either, and things are getting worse as the baby boomers retire. We simply need more of everything. Cutting one to raise the other doesn't solve the problem, it merely shifts it to a different area.

 

What you are proposing is very similar to general internal medicine.