Quote of the day
There is NO single payor system that compensates physicians on health outcomes. None. There are a bunch that pay for ticking boxes (e.g. did you talk about smoking cessation, did you talk about weight loss, etc.) But not a damn one pays based on outcomes. Why you ask? Because as sure as the sun rises I and every other general surgeon would IMMEDIATELY stop operating on 1. smokers, 2. the obese, and 3 diabetics on an elective basis. They talk a big game, but every time someone points that out to the powers that be they back down. Hell, even REPORTING outcomes has caused a drop in elective CABGs in NY, a rise in emergent ones and worse outcomes across the board.
William Bromberg, in a comment here. I don’t know if that’s completely true, but I’m sure this fundamental problem is in no way limited to surgery even if that’s probably (one of?) the field(s?) where such a change in incentives structures would have the highest impact; in general, if you compensate doctors based on whether the patients get better or not, then it gets harder to get (/enough) doctors to treat the risky cases and/or the very sick.
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