I don’t think you’d get many arguments from anyone that our
nation’s health care system could use some help. So many are uninsured,
and even those who are insured can’t always decipher their policies.
HMO, PPO, copay, out-of-network, it’s hard to tell what’s
what, and it’s just as confusing for the billing departments at
hospitals and medical offices.
The most commonly used system for reimbursement to medical providers by
insurance companies is fee-for-service, in which doctors treat patients,
and insurance companies compensate. In this scenario, doctors make more
money if they see more patients and run up some costs. Many feel this
system is based on speed rather than building strong doctor-patient relationships.
There is now a new system gaining popularity. It’s called pay-for-performance
and issues a flat fee per patient. Doctors can make more money by meeting
specific quality standards and also by cutting costs (which in most cases
mean restricting treatment). The idea is to reward doctors for providing
better care, but skeptics question whether or not it will strengthen doctor-patient
bonds. For instance, if a patient complains about a stomach ache and desires
a full set of tests and scans, but the doctor feels it’s not medically
necessary, is this helpful to the patient? The doctor will save money
by not running the tests and thus make more money, but is the patient
There’s much to consider when it comes to our health care system.
You’ll most likely be hearing more about this pay-for-performance
system, so keep your ears open. For some more information and an interesting