Here we go again. Once an idea gets fixed in certain minds, it never goes away. Politico reports –
The National Commission on Physician Payment Reform is calling for eliminating the fee-for-service model within seven years, starting with a five-year transition period to a blended payment system.
This commission is chaired by Bill Frist, MD, former Senate Majority Leader. He also wrote an op-ed with Steven Schroeder in which he says we can abolish FFS within five years. He writes –
Lawmakers, care providers and insurers must act now to change physician pay incentives to ultimately improve how care is delivered and ensure that the cost of that care is affordable for generations to come. That means moving away from fee-for-service now.
Dr. Frist thinks the SGR (Sustainable Growth Rate) cuts in Medicare payment to physicians should be replaced by cuts in “physician payments and reductions in inappropriate utilization of Medicare services.” I’m not sure how his substitute is any different, but the commission thinks the whole shebang could be replaced by Accountable Care Organizations (ACOs) ― something that wasn’t even a gleam in the eye of the Dartmouth Health Atlas five years ago.
There is absolutely no support for the notion that ACOs will do anything ― anything ― to reduce costs or improve quality (see this recent NCPA blog, “Question: Why Did Anyone Ever Believe in ACOs?”). It is nothing more than a wish dressed up with high-falutin’ language (sustainable, cost-effective, high-quality, interoperable, coordinated, etc.) In fact, virtually all of the evidence indicates just the opposite ― that the elements of ACOs (disease management, pay-for-performance and so on) are useless or worse.
We have written here ad nauseum that the problem in health care is not fee-for-service, but third-party payment. Almost everything we do during the course of a day is done on a fee-for-service basis and none of it results in high inflation or poor quality. Quite the opposite. The only difference in health care is that someone else is paying the bill, so there is no constraint on the consumer or the provider of services.
There is no clever trick for overcoming that problem. We have already tried capitation, price setting, rate regulation, RBRVS, DRGs, and a host of other gimmicks. None of it works. And the new magic formula, ACOs, will not work either.
More importantly, if I choose to pay my doctor a fee for providing me a service, who the hell is Bill Frist to tell me I cannot? Multiply me by a million, or ten million, or a hundred million, how is it any of Bill Frist’s business? If we millions decide to pool our money into an insurance mechanism that pays our doctor’s fees for providing services, what gives Bill Frist the right to forbid it?
Now Dr. Frist is free to refuse accepting fees for the services he provides. Since he feels so strongly about it, I encourage him to do just that. He can even encourage his friends and colleagues to do the same. Good for them.
Here’s a novel idea for Dr. Frist (and Michael Bloomberg, for that matter) — How’s ’bout we all mind our own business? I won’t tell them what to do and they can show me the same courtesy. I expect we would have a much happier country.