Friday, July 8, 2011

Amerling: The End of Fee-For-Service Medicine

In the 7/5/2011 Health Reform Report, Dr. Richard Amerling discusses the latest attempted "reform" and what's wrong with it. Here's an excerpt from, "The End of Fee-for-Service Medicine":
The payment transition from the current fee for service to salaried status also also creates a loss of autonomy for physicians. Doctors will have no choice but to follow hospital dictates regarding length of stay, choice of medicine, and adherence to clinical practice guidelines, many of which are either obsolete or inappropriate. The practice of medicine will become textbook instead of individualized to the patient...

The payment transition from the current fee for service to salaried status also also creates a loss of autonomy for physicians. Doctors will have no choice but to follow hospital dictates regarding length of stay, choice of medicine, and adherence to clinical practice guidelines, many of which are either obsolete or inappropriate. The practice of medicine will become textbook instead of individualized to the patient...

FFS has been wrongly blamed for runaway health spending, when the real culprit is the third party system, unrestrained by meaningful co-pays or deductibles...
(Read the full text of "The End of Fee-for-Service Medicine".)

Dr. Amerling has it absolutely right. Eliminating fee-for-service will create perverse incentives for doctors and will ultimately harm patients.

Medical organizations should be left free to work out the best incentive structures that suit their particular needs and circumstances. It may include straight salary, salary-plus-productivity-bonus, or pure fee-for-service. For government to declare any one model as wrong and compelling doctors to work under its preferred system violates the rights of doctors and patients to contract to their mutual interest according to their best judgment.