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Lets talk about merit pay from a doctor's point of view.... [View All]

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busymom Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Mar-11-09 05:57 PM
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Lets talk about merit pay from a doctor's point of view....
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Edited on Wed Mar-11-09 05:58 PM by busymom
I know it will be unpopular...because as a matter of point, doctors earn more than teachers (of course they do 4 additional years of schooling and 3-10 additional years of residency and fellowship training, have ~150,000 in student loans and pay exhorbitant malpractice rates ...) but here it is (at the request of someone in another thread).

Physicians in the internal medicine practice here are now paid and judged (as being good or bad doctors) by insurance companies and dr. rating agencies based on things like their patient's a1c levels. If you are a diabetic patient but don't do a super-good job of controlling your blood sugar by exercising and eating right, think twice. Your doctor will be dinged, paid less,will get a poor rating and in the case of the doctors here, the companies will post a quarterly "doctor quality rating" in the local newspaper. There are some doctors who simply are now making it difficult for their less compliant diabetic patients to get an appointment in hopes that they will go elsewhere and ruin someone else's ratings.

There is one doctor in the group who is probably the best clinician. She also takes a great deal of time with her patients and is very thorough. She regularly sees her name at the bottom of the list of "good doctors" though because she doesn't abandon her patients or make it harder for them to get appointments. She suffers for this in measurable ways though, and it is wrong.

The trend is now moving to judging doctors based on their patients smoking and obesity in similar ways....this means that the more overweight patients or smokers that you have, the worse your quality rating will be as a doctor. The idea behind this is that a GOOD doctor will help their patients quit smoking/lose weight, etc. Forget personal responsibility, I guess.

Also, my husband (who regularly sees patients w/o insurance and does not bill them in many circumstances) has to PAY out of his pocket for translators for patients...as do other physicians. This means that if you come into the office and have medicaid (that will only pay about $17 for your visit anyway...not enough to pay for him to read through your chart, familiarize himself with your illness, take a thorough history and listen to you and examine you and then come up with a treatment plan, and pay for his nurse, the electricity, etc) he may have to pay $200 out of his pocket to have someone come in and translate.

Obviously, accepting non-english speaking patients is becoming very unpopular.

The newest thing? Medicare doesn't want to pay for treatment for infections that come back after a patient is discharged from the hospital. So...if you leave the hospital and stop taking your antibiotics, or....for some reason the infection returns, the hospital and doctors will not be compensated.

The result of all of these changes is of course that doctors slowly will just not want to see people who are overweight, smoke, have uncontrolled diabetes, don't speak english or...may end up being not very compliant.

It really affects patient care and makes a lot of doctors feel unhappy because most of them really care about their patients and want to help them/treat them and feel resentful of being judged as less than simply because of the bizzarro rating system.

There's that perspective...
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