Obamacare 2.0: the White House's radical new plan to change how doctors get paid

[Triana]

The White House is making its biggest bet yet on the future of health care — and it has nothing to do with getting more people health insurance.

The Obama administration announced Monday a sweeping new plan that will directly affect thousands of hospitals and doctors across the country. The federal government now plans to pay Medicare doctors more if they help patients get healthier — and less if their patients just stay sick. This would be done by tying 85 percent of all Medicare payments to outcomes by the end of 2016 — rising to 90 percent by 2018.

The idea is to move away from the broken and expensive "fee-for-service" system, which pays doctors a flat amount for every surgery and physical they perform — even if they do nothing to actually help a patient.

MEDICARE WILL PAY DOCTORS MORE WHEN PATIENTS GET HEALTHIER

If this works, the White House hopes it will do two things. The first is improve the quality of health care in the United States, by paying doctors the most when they provide the best care possible.

THE REST:

http://www.vox.com/2015/1/26/7913015/obamacare-doctor-payment-burwell

[Vattel]

1. stupid idea that hurts the most ill and the most poor.

[NoJusticeNoPeace]

3. Explain

[Vattel]

13. It doesn't discourage doctors from over-prescribing.

It does make medicare even more of a bureaucratic nightmare for them which often results in good doctors pretty much bailing on poorer areas with more medicare patients. It does incentivize better care, but I really don't see most physicians being affected by that. Most of them are already trying to give good care. It does incentivize practicing types of medicine that typically have good outcomes. That is a perverse incentive.

[NoJusticeNoPeace]

14. Incentivizing good medicine is a perverse incentive?

[Vattel]

15. No, incentivizing types of practices that typically have good outcomes is the problem.

If I specialize in ovarian cancer treatment, I will lose a lot of patients even if I am an awesome doctor.

[NoJusticeNoPeace]

16. Who says? That is ridiculous.

You think they are so stupid they dont take that into account?

That is ABSURD

[Vattel]

17. Calm down and just tell me how they would take that into account.

I don't mind being schooled.

[NoJusticeNoPeace]

18. If your job is to take care of terminal patients, you are then saying they would punish you

financially if your patients die, right?

Is that what you are saying?

Terminal or very sick patients, who are far more likely to die within a certain amount of time, etc.

Right?




Calm down?



Calm down?



Why you no good bleepydebleepin mofarking god dang



just kidding, i am calm

[Vattel]

20. Palliative care of terminal patients is one thing. That would be easy to make an exception for.

Is there such an exception in the works? I don't know. I wasn't really talking about that sort of case though. I was talking about the choice of a specialty. Not all kinds of specialties have the same success rate in terms of patients getting better.

[daredtowork]

23. I think the argument is

the doctors who choose to help the most in need will be the least "incentivized".

Again.

Perhaps calm is the wrong reaction.

Since reasonable discussion resulted in being treated like a doormat in the past.

This is a matter that needs to get HEARD.

We need to incentivize the doctors and other highly trained professionals who dedicate their skills to public service.

[tridim]

5. It hurts shitty doctors.

And thus helps everyone avoid shitty doctors.

How do you think this hurts the poor? It's a great idea, and a huge part of the move to single payer.

[eShirl]

10. The doctors that help the sickest patients will be penalized.

Doctors that consciously take only those patients most likely to get healthy, will be rewarded for it. The sickest will get dumped.

[tridim]

11. No they wont. There will be exceptions for serious chronic illness. nt

[former9thward]

21. So then everything becomes a "serious chronic illness"

To do this with Medicare is ridiculous. Medicare takes care of the old and therefore the least likely "to get healthier." And what does "get healthier" mean? A totally subjective term and yet another way to game the system even more than it is.

[NoJusticeNoPeace]

2. This will drive some folks nuts...

Sounds rational to me, however

[LawDeeDah]

4. MEDICARE WILL PAY DOCTORS MORE WHEN PATIENTS GET HEALTHIER

and this will make some folks here go ballistic like this is a bad thing. Wait, it will be twisted into some grotesque and evil plan Obama has for sick people.

[Jackpine Radical]

7. It would not fund end-of-life care?

Often, it is a medical triumph to merely preserve a function, or just to slow its decline. A lot of people just aren't going to "get healthier." Should they be denied palliative and other appropriate care?

And what are the measures of "healthier?" I could see this turning into a disaster in the realm of psychotherapy, for example.

[LawDeeDah]

9. I haven't read the entire article, it's quite lengthy and very interesting.

Doctors get paid more when they deliver more medicine

The best way for a doctor to make money in the United States for decades now has simple: prescribe treatments.

The American health-care system by and large runs on what experts describe as a "fee-for-service" system. For every service a doctor provides — whether that's a primary care physician conducting an annual physical or an orthopedic surgeon replacing a knee — they typically get a lump sum.

That's how most businesses work. Apple gets more money when it sells more iPads and the Ford gets more money when it sells more cars. But health care isn't like iPads or cars. Or, at least, it's not supposed to be.

---

But here's the thing: most American doctors aren't paid on whether they deliver that improved health. Their income largely depends on whether or not they performed the surgery, regardless of patient outcomes. Their patient's knee could be good as new or busted as always at the end — but, in most cases, that doesn't factor into their surgeon's ultimate pay.

==


Maybe you can cut/paste what you are talking about that the article covers?

[QuebecYank]

6. Prescription fees!!!

In Quebec Canada, the provincial government wants to do away with doctors getting paid for every prescription they write. Which makes sense, because a lot of doctors on both sides of the border are working (on the side) for pharmaceutical companies. Pushing drugs onto their patients, that may/may not be needed or work. These doctors get money, expensive trips, etc., from the pharma companies.

[LawDeeDah]

8. +++ those doctors are imposters. And there are a lot of them.

weed the greedy backstabbing shits out.

[global1]

12. I See Two Possible Flaws In This....

Don't get me wrong I'm all for paying Docs more for good outcomes and getting people healthy/healthier. The Docs still need to get paid on outcomes if they treat someone and that person doesn't get healthier as well - but maybe not as much.

The two flaws I was talking about:

1. A Doc might do all he/she can to help get the patient healthier - but there is a responsibility of the patient that goes hand and hand with that. The patient needs to heed the Docs instructions. Needs to comply with the meds that the Doc might prescribe as well as any diet, physical therapies, etc. If the patient doesn't listen to the Doc and follow the advice and take the meds - why should the Doc be penalized for the lack of cooperation by the patient. I'm wondering how they will compensate for this in this new payment scheme.

2. If a patient is really in bad shape and the Doc accesses that in the examination - the Doc might opt to not care for a patient that they don't see any chance on getting healthier. That might mean that the sickest amongst us - might not get the care we need or any care for all that matter. How do you control for that in such a payment scheme.

We have to face realities here - some patients do not get healthier. That has to be taken into consideration.

Now if they target some disease states and conditions that it is well know the therapies involved can make a difference in a patients health - then maybe they are on to something. I just don't know if will work to the good on a global basis.

[WillowTree]

19. In geriatrics, it can often be counted a success if the patient just doesn't get worse.

[daredtowork]

22. Does this disincentize a doctor from confirming disability?

Will doctors who have thrown a series of medications at patients declare them improved if any test result changes? Will admission of one symptom improvement be taken as "total" improvement so the doctor can get paid while the patient is disqualified from services?

Hmm, I suspect this isn't going to end well for disabled people.