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Should Physicians Get Paid Relative to Their Performance?

When I was a high school teacher about ten years ago, performance based teaching was a new idea that was getting a lot of attention. Should teachers be paid on a scale relative to how well their students’ perform on state testing? At the time educators were outraged because there were way too many factors out of our control to determine whether we were doing a good job or not. Now doctors are facing the same scrutiny and hopefully will be able to avoid this system. As a student in a vocational nursing school, you’ll read about a lot of ideas to trim budgets; some will be good, some will make you wonder “who would think these crazy ideas would work?”

On amednews.com, Charles Fiegl explored this topic and states, “The health system reform law requires the Centers for Medicare & Medicaid Services to use a value-based payment modifier — another term for pay-for-performance — for some physicians starting in 2015. The modifier would adjust payments to physicians based on the quality of care they provide and how much cost they incur relative to their peers during the course of a reporting period, CMS said. All physicians in the program would be subject to the modifier starting in 2017.”

In my opinion, there are a million variables as to a patient’s health and recovery. One sector of patients my live near a refinery and have a greater chance for respiratory issues or cancer. Another group may have a lower income and can’t afford quality food or exercise regimes. A third group may be a community of a certain race and have a specific genetic disposition (being Japanese, my family has terribly high blood pressure for example). If you sit down to really think about it, it is impossible to have a level playing field.

“In the same fee schedule rule, CMS has proposed applying its multiple procedure payment policy to the professional component of certain advanced imaging services, such as MRIs and CT scans, starting Jan. 1, 2012. The agency already reduces pay for the technical component of multiple advanced diagnostic scans, which impacts health professionals who provide the screenings.

“Expanding the policy would reduce payments for physicians who interpret multiple advanced imaging scans provided to the same patient on the same day… For instance, a physician interpreting two MRI scans on the same patient would receive full payment for reading the first scan, but 50% less for reading the second and any subsequent scans,” explains Fiegl.

How scary is that? If my doctor thinks he sees something abnormal in my body, you bet I’d want multiple readings of a possible disease. Isn’t this also preventative medicine? It seems like it would be cheaper to do a couple of scans to find a problem early on than the time, money and stress that would be invested once the problem reaches greater proportions.

Being in an vocational nursing program, there is a ton of information you have to learn. Dealing with management and learning hospital protocol just might be the least fun.

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