Comments on: Free the Doctors

By: Raymond Kordonowy MD

Raymond Kordonowy MD — Fri, 04 Dec 2009 22:38:41 +0000

I agree that we need a free (er) market. The most basic, fundamental aspect of any economic model is missing in the present payment schemes. This is accountability- both from the provider’s end as well as the consumer end. Any model that doesn’t deal with this will never be fair or maximally competitive. This is probably why you don’t hear much from physicians on this topic (a hunch only).

By: Free the Doctor | John Goodman | NCPA

Free the Doctor | John Goodman | NCPA — Wed, 02 Dec 2009 15:31:46 +0000

[...] timid idea: let doctors participate in “gainsharing” in federal pilot programs. Our bold idea: Free, liberate, release, unshackle, untie, untether, uncage, unpen, emancipate once and for all [...]

By: Ravi

Ravi — Thu, 23 Apr 2009 06:20:55 +0000

Hi…
You know how much I appreciate Plato’s distinction, the difference between “slave doctors” and “doctors befitting free men.” With thought leadership like yours, there may be a chance that both we as citizens and as physicians may share the advantages of the latter.
Thanks

By: Felix Rogers, D.O.

Felix Rogers, D.O. — Fri, 03 Apr 2009 02:07:33 +0000

Thanks John. As a physician I agree. For another case study in both the value and reimbursement issues associated with innovative programs look at the following web site. This is a comprehensive approach for the treatment of High Cholesterol, lab work through script, which clearly provides the higher quality at a lower cost and with more convenience but the reimbursement model for physicians is problematic.

http://www.netcareclinic.com

By: Steve Seater

Steve Seater — Thu, 05 Mar 2009 17:26:27 +0000

I have used Minute Clinics staffed with nurse practitioners for primary care. My experiences have been most satisfactory. This prompted me to do a little research into the field of advanced practice nursing and, not to my amazement, I discovered that nurse practitioners enjoy haigher patient satisfaction than do doctors in a majority of cases. Why not give all primary care to nurse practitioners and specialty care to MDs? Wouldn’t this save lots of money and still provide excellent care? My visits cost me less than $50.00.

By: Steve Austin

Steve Austin — Wed, 04 Mar 2009 14:17:26 +0000

I read with great interest your notion that insurers/payors are actually hindrances to reform. You make a compelling argument that I must agree with and, to my own dismay, I must further admit that a governmental entity (Medicare) may actually serve as the driver for the necessary reform. That really flies in the face of my free market bones–but so does the banking fiasco we’re dealing with. But I digress….
Notwithstanding my agreement with your points, I do not perceive the medical profession as having ever been interested in promoting anything other than its own elitist agenda, which may be a huge drawback to any kind of reform, be it driven by supply- or demand-side. Granted, your article allows, rather mandates, that reform not cost the doctors in lost revenue, but when are we ever going to deal with the notion that this form of public service has an innate right to $.5 million + salaries, while our teachers and police grovel for a fraction of the wage? Doesn’t add up to me, though I realize med school is no small financial proposition.

By: Stanley Feld

Stanley Feld — Wed, 04 Mar 2009 14:11:08 +0000

Bravo John

Well articulated. http://www.ncpa.org/pub/ba647/

By: John Goodman

John Goodman — Tue, 03 Mar 2009 15:49:48 +0000

The link to the Vision Chapter is:

http://www.ncpa.org/email/State_HC_Reform_Book_conclusion.pdf

By: John Goodman

John Goodman — Tue, 03 Mar 2009 15:18:17 +0000

To Jeff Mumm and William Boyles:

I do favor opening up the market – especially to nurses, physician’s assistants and others. I do not favor fraud. I do favor free markets.
I have no opinion on how much doctors should be paid. If they are free to repackage and reprice their services, productivity (and patient welfare) should rise.

To Ernest J. Bordini:

Not sure I agree, but I’m willing to let the market decide. See my chapter on how I envision some of these problems being solved.

By: Ernest J. Bordini, Ph.D.

Ernest J. Bordini, Ph.D. — Tue, 03 Mar 2009 01:50:15 +0000

Nice thought if you assume a production model for surgeries, but there is no way to lower cost for educational preventative services and time spent doing so, since the outcomes may not be measurable for many years. Also does not work well for diagnostic procedures, good diagnosticians dont only consider one question or problem per visit or rely on one one test.

More tests mean more costs up front, but less so in poor treatment for the wrong thing, but all the insurers will look at is it costs more for a work-up at comprehensive clinic than at the phrenology clinic or the clinic where the diagnostic assessment consists of the patient telling the doc they need medicine x because they have common symptom B as they saw on television.

Create an outcome based reimbursement system and you will create a system where the best docs only take the less severe cases. The only way to bring quality back into the system is for Medicare physician fees to come more into line with what the better doctors see from private patients and to allow and create better incentives versus penalties for proper diagnosis in the first place.

In most cases reimbursement for reviewing records is not allowed and time for report preparation is grossly underestimated. It creates a system where records are not sought, and review of findings and reports are often so brief they must be redone.

Fact is, the fees people are paying into the system are too low. It may be unpopular to say you need to pay more for better services, but years of promising more for less is being now followed with more promises of more for less.