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Are salaried physicians the key to health reform?

For decades, the American Medical Association has violently opposed any system other than fee-for-service medicine, but virtually any health reform that works is likely to require changes to physician payment models. That the system will change, at this point, is basically a done deal; the question is what those changes will be. And that all turns on what policymakers feel will offer the most appropriate incentives.
 
One option that's gotten a lot of attention over the last week is the clinic model, with President Obama giving it a conspicuous nod with his visit to the Cleveland Clinic. That model, which relies on keeping physicians on salary, seems to produce high-quality results at lower prices than comparable institutions using independent physicians for care.

It's not just giants like the Cleveland Clinic that have benefited from this model, however. Another example was written about in the New York Times, which profiled Cooperstown, N.Y.-based Bassett Healthcare, a 180-bed hospital which employs all of the 260 physicians who work there.

Medical costs there are lower than 90 percent of the state's facilities, and care quality ranks among the top 10 percent in the nation, according to surveys. The hospital's leaders say they offer salaries competitive with money earned in a fee-for-service setting. This may be because physicians have little incentive to order needless tests or procedures, and plenty of opportunity to coordinate care and share best-practice guidelines.

Also, as is common at clinics like Mayo and Cleveland, patients find that doctors remain in closer touch than when they're seen by independent practitioners. The problem, though, as readers of FierceHealthFinance readers know, is that it's very hard to get physicians to give up independent practice.

Seems that the DC policy wonks should function on that one piece of the problem--how to make salaried physicians feel as empowered as possible. That problem also falls into your lap, readers: Have any of you hit on a formula that helps physicians transition into roles as employed people without feeling too compromised financially (or personally)? If so, what has worked?

To find out more about Bassett:
- read this New York Times piece

Related Article:
Obama administration points to Cleveland Clinic as reform model

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Comments

Your attitude is insulting. What works for the Mayo clinic or Cleveland clinic is not necessarily the best model for the rest of the country. One downside of employed physicians is that when you have smaller facilities, controlled by not the sharpest-pencil-in-the-drawer administrators, there is a very real attitude to start holding quality of care hostage. That is, if a hospital screws up, cuts corners, whatever, the hospital signs the check and it happens that the doctor finds out he/she can either shut up or hit the road.

I don't want to be an employed physician, and there are tens, if not hundreds of thousands of us out there who are not. This is probably especially true in the specialty field.

The Mayo Clinic and Cleveland clinic are the aberrrant models, not private practice. Yours is the smarmy attitude that keeps us in private practice.

You'll notice this article talks about the need to empower physicians precisely so that they can avoid this kind of dilemna. When physicians have the chance to have a say in the administration of care within their hospitals, as they do at both Mayo and Cleveland Clinic, the result is a collaborative model which provides better care with less waste. Nothing in the above article is "smarmy" in the least as they clearly reference the need for this kind of joint decision making.

When do we salary attorneys, plumbers, insurance agents and car salesmen? I do not wish to have the worst brain surgeon making the same amount of money than the best, nor do I want them doing my brain surgery.

Of course who decides how much each specialty makes? That should be fun...

In the same vein, then all offices will become government salaried positions? File clerks, aides and nursing will be rolled over to the government employ? Who is paying the rent and electricity?

Control of liability is always left out of this discussion also. Tort reform must be at the forefront of this discussion. Also the general public needs to understand that if things don't go your way, you can't sue everyone for your misfortune.

John Kerry was harping on the reduction of "administrative costs" to reduce the cost of health care, which of course it would. When have we seen government mandates reduce the administrative costs.

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