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Fri Feb 15, 2013, 03:56 AM

 

At Long Last, We Are Treating Doctors Like We Treat Teachers

Almost two years ago to this very day, I wrote a couple of largely hypothetical pieces that toyed with the idea of performance pay for physicians, similar to what's being forced on educators. The first hammered out some specific proposals for doctors, such as the use of a few fundamental metrics, like BMI, cholesterol, and blood pressure, to evaluate doctors and hospitals . I doubled down the second time by suggesting that our health care workforce is failing and that our continued decline in overall wellness is ruining our economic competitiveness. If you follow the education reform debate, you'll read suspiciously similar sounding aspersions cast against our public schools and its teachers.

The New York Times published a piece in January of this year about a new program in New York City attaching quality of care to physician income. We would have, at long last, a health care system accountable to patients. From the article:

The proposal represents a broad national push away from the traditional model of rewarding doctors for the volume of services they order, a system that has been criticized for promoting unnecessary treatment the public hospital system has come up with 13 performance indicators. Among them are how well patients say their doctors communicate with them, how many patients with heart failure and pneumonia are readmitted within 30 days, how quickly emergency room patients go from triage to beds, whether doctors get to the operating room on time and how quickly patients are discharged.


Doctors, unsurprisingly, do not seem too thrilled about this proposal. Of the reasons cited in the article, they could be docked for conditions outside their control. Some physicians would simply game the system by, for instance, "refusing the sickest and poorest patients, who tend to have the worst outcomes and be the least satisfied." Or, doctors could measure something frequently and report the lowest number... It looks like, according to the proposal, public hospitals specifically and their physicians are in greater trouble. They do not have the luxury of choosing patients and are likely to receive the most difficult cases...

To all my educators out there: is this starting to sound familiar...?

http://www.huffingtonpost.com/shaun-johnson/merit-pay-for-doctors_b_2681218.html?utm_hp_ref=tw

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Response to HiPointDem (Original post)

Fri Feb 15, 2013, 04:35 AM

1. Fine with me. Now can we start paying bankers based on performance too?

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Response to NC_Nurse (Reply #1)

Fri Feb 15, 2013, 04:37 AM

2. ain't gonna happen unless they're small, local, politically unconnected banks or credit unions

 

affiliated with public unions.

but i'm not so sanguine about performance ratings for doctors. considering how the proportion of doctors who are essentially employees of corporations is growing (v. independent practitioners running their own practices), i suspect that this will not turn out to be good for either patients or practioners.

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Response to NC_Nurse (Reply #1)

Fri Feb 15, 2013, 05:38 AM

5. When you say this, what exactly do you mean?

 

Who are you specifically talking about when saying bankers?
I have three friends that consider themselves bankers as they work for about $11 an hour in a bank.

Are you talking about CEO's of a corporation bank?
If so, they indeed are paid for their performance by their shareholders who are their bosses.

If the shareholders do not like someone, they are fired and retired and replaced by another CEO.

(same with brokerage houses).

No CEO continues to be CEO if the shareholders of the corporation don't like the job they are doing, no matter which job.

So it would be the shareholders of the companies that need talking to.
not the CEO themselves (and the stock most CEO's own are performance related to, a part of their salary so to say, but that would need to talk to the CPA's to figure out.
(which is why they always want to get rid of the capital gains part of the income tax,
as most higher end salaries are considered capital gains/loss and not salary itself, which is normally very small.

That would require talking to the republicans in the house to change those rules.
And force them to pay the 35% or whatever and not just 15%(number random).

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Response to HiPointDem (Original post)

Fri Feb 15, 2013, 05:34 AM

3. This is good re public hospitals

Outside of that sphere it can't be imposed.

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Response to cali (Reply #3)

Fri Feb 15, 2013, 05:36 AM

4. yes, if your aim is to destroy public hospitals. which is the aim.

 

but you're mistaken if you think such a system can only be used in public hospitals.

it can, and will, be used in private corporate hospitals on doctors who have been reduced to dependent employees, wage laborers just like janitors and orderlies.

"The bourgeoisie has stripped of its halo every occupation hitherto honoured and looked up to with reverent awe. It has converted the physician, the lawyer, the priest, the poet, the man of science, into its paid wage labourers. "

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Response to HiPointDem (Original post)

Fri Feb 15, 2013, 07:06 AM

6. Welcome to the "ownership society". Only the "owners" have rights.

Everybody else gets measured, graded, and weeded out.

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Response to bemildred (Reply #6)

Fri Feb 15, 2013, 07:19 AM

7. it's their plantation, we just work on it.

 

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Response to HiPointDem (Original post)

Fri Feb 15, 2013, 08:42 AM

8. Like education, we could issue the poor

medical vouchers so they can choose the best doctors and hospitals. We could call it "single payer".

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Response to HiPointDem (Original post)

Fri Feb 15, 2013, 09:02 AM

9. Problem is, every doctor's client eventually ends up dead

so every doctor is going to look like a failure.

It's not like a teacher, who has the possibility at least of having every kid in her classroom pass on to the next grade.

Doctors lose 'em all. And no amount of skill or knowledge can change that.

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