http://www.arktimes.com/ArkansasBlog/archives/2013/01/12/merit-pay-for-doctors Comments On: Merit pay for doctors by Max Brantley en-us Copyright 2013 Arkansas Times. All rights reserved. This RSS file is offered to individuals, Arkansas Times readers, and non-commercial organizations only. Any commercial websites wishing to use this RSS file, please contact Arkansas Times. robert@arktimes.com (Arkansas Times Webmaster) Tue, 21 May 2013 00:00:01 -0500 Tue, 21 May 2013 13:15:00 -0500 Foundation http://blogs.law.harvard.edu/tech/rss Posted by Yellowdogdaughter]]> Sat, 12 Jan 2013 20:02:29 -0600 Arkansas Times
I was taught a few rules: 1 Be realistic as to how many you can see an hour, you can't put 5 quarts of milk in a gallon jug. 2 If your schedule starts at 830, be at your desk by 815. If you start at 100, skip lunch if you have to but be there at 1. 3 . Phone calls from your lawyer, your broker, your best friend and your banker should be handled when you aren't seeing patients. 4) When you are running late (varies for docs, I guess but I used 30 minutes) walk in and apologize to your patient.

That being said, I couldn't always run on time. Patients show up at 1 for a one o'clock appointment and leave their brand new insurance card in their car. Someone who just found out they acquired genital herpes from their spouse of 20 years cant be handled in a 20 minute spot. My own family has broken bones and car wrecks. You do your best to accommodate TWO appointments for a husband and wife who while driving in from 90 minutes away hit a deer and arrive an hour late. The list is endless.

All you can do is try to do your best and treat patients the way you would wish to be treated.
Posted by olddoc]]> Sat, 12 Jan 2013 18:32:34 -0600 Arkansas Times
Yellowdogmama will agree with you about the pharmacists. She'll go there first every time....once even for a consult about whether or not stitches would be necessary.
Posted by Yellowdogdaughter]]> Sat, 12 Jan 2013 17:14:45 -0600 Arkansas Times Posted by Atlas999]]> Sat, 12 Jan 2013 16:37:57 -0600 Arkansas Times
Don't assume those cute little reps are slowing down your doc too much. Many times they move from the waiting room to the hall, stand there for 20 minutes and beg a signature from the doc as he quickly nods his head and walks by, then leave their samples and walk out. Not a funny easy job if you ask me.

You can check to see how much your doctor receives from Phama (I'm not sure how accurate it is) http://projects.propublica.org/docdollars/
Posted by olddoc]]> Sat, 12 Jan 2013 16:24:32 -0600 Arkansas Times
http://www.usatoday.com/story/money/busine…
Posted by Vanessa]]> Sat, 12 Jan 2013 16:20:39 -0600 Arkansas Times Posted by Doigotta]]> Sat, 12 Jan 2013 15:46:50 -0600 Arkansas Times Posted by Yellowdogdaughter]]> Sat, 12 Jan 2013 15:19:27 -0600 Arkansas Times
elwood," Perhaps not fitting but I suspect olddoc will tell us treatment with drugs is how most major illnesses are handled"

Prevention is the best medicine.
Posted by Diogenes]]> Sat, 12 Jan 2013 15:15:10 -0600 Arkansas Times
Perhaps not fitting but I suspect olddoc will tell us treatment with drugs is how most major illnesses are handled.

Until that aspect of American healthcare faces some cost containment/regulation we're going nowhere but down. When $15 worth of breathing meds are allowed to be sold for $244 then costs are going nowhere but up. Most of that markup goes into the pocket of your favorite corporate pharmacy chain.
Posted by eLwood]]> Sat, 12 Jan 2013 14:23:47 -0600 Arkansas Times
To summarize decades of bickering economists: there is too much relevant information to gather and process, and it is almost certain any centrally planned solution will suck.

I do wish them luck. Blind pigs and acorns, monkeys and typewriters, etc.
Posted by Gylippus]]> Sat, 12 Jan 2013 14:05:29 -0600 Arkansas Times
If you follow the money, it seems we WANT people to have heart attacks and bypass, diabetics amputate feet and dialysis, not be stay healthy with real primary care.

US primary care has been dysfunctional due to reimbursement for a generation, as people get sicker. There is not time for them to do practice and make a living and pay overhead, they end up as referral taffic cops. 30 min w/ a person rather the 13 min-if you are lucky- can help a lot.

BTW, UAMS, if you follow the money, cares diddly squat about family practice. The one clinic building at UAMS not connected by a walkway- The Family Medicine Clinic. Maybe Ms Goodhand will get to take a walkway with her to TN.
Posted by Diogenes]]> Sat, 12 Jan 2013 13:33:26 -0600 Arkansas Times Posted by Atlas999]]> Sat, 12 Jan 2013 13:00:02 -0600 Arkansas Times
It would be nice of the low-information Arkansas voter would hold their elected officials responsible for something besides guns, gays, and God. I wonder if they will hold them responsible when they lose income or gramnny comes to sleep on the couch in the living room.
Posted by couldn't be better]]> Sat, 12 Jan 2013 12:25:28 -0600 Arkansas Times
I think the answer is clearly YES! the are differences, the question is how to measure them.

It is not unusual for doctors and their families to rely on doctors who may be less charismatic practicing in older facilities in less tony areas of town. By the same token I image if you told an assistant principal at a school she was selected to start a brand new school and she could have her pick of any five teachers from her current school, I suspect she'd know a dozen that she wanted and a dozen she could do without.

Neither teachers nor doctors are commodities that can be interchanged. The problem is measuring the differences.
Posted by olddoc]]> Sat, 12 Jan 2013 12:03:11 -0600 Arkansas Times Posted by Verla Sweere]]> Sat, 12 Jan 2013 11:35:34 -0600 Arkansas Times Posted by Doc]]> Sat, 12 Jan 2013 11:20:58 -0600 Arkansas Times
Mostly it is a yawn. That stuff already exists. Medicare pays more (or penalizes less if you electronically prescribe (though US owned LRAFB REFUSES to accept e prescriptions). Same process for PQRI in which you have to certify you did PAP smears, and flu vaccines, and limited readmissions; a list of some 100 quality measures.

So yes, your doctor gets at least part of his pay via Merit Pay.

But, in reality, it is the worst of the "flat fee" systems. Insurance pays the best hip doctor, the best psychiatrist, the best oncologist THE EXACT SAY AS THE NEWLY GRADUATED DOCTOR with no increase for seniority......think what the unions will do with that!

Get rich? Not the motivation for most docs and when I look at the country club directories or the 6 most expensive homes I see some docs, not a lot. I've hired docs for under $100,00 and only once paid more than $140,000. Nice pay but it requires 10 -15 years of rigorous work after high school just to start practice with debt would crush many folks.

Some do extremely well financially, some work hours I can't imagine (and we all know that even a meter maid in LR can make 6 figures if she works lots of overtime) with every 3rd or 4rth night responsibility for responding to emergencies. I'm not trading my life, or my family's life for 3 times the income. Others make different choices.

It is said the average US doc needs 3 employees to handle billing. In Canada one clerk can handle 3 doctors because of the simplicity of the single payer system.

A single payer system, with unionized doctors, would be a huge step in the right direction.
Posted by olddoc]]> Sat, 12 Jan 2013 11:19:26 -0600 Arkansas Times Posted by Yellowdogdaughter]]> Sat, 12 Jan 2013 11:10:00 -0600 Arkansas Times Posted by 70%er]]> Sat, 12 Jan 2013 10:59:45 -0600 Arkansas Times
Given that many doctors only seem to be doctors because it's a profession in which one can become very wealthy - I have a couple like that in my family - the last thing we need is more financial rewards.
Posted by I_AM_THE_NRA]]> Sat, 12 Jan 2013 10:19:32 -0600 Arkansas Times Yep, every patient can get better, no matter what else is going on.
I wonder in what educational field the folks who come up with these ideas studied. Statistics, maybe?

None of the above is meant to imply that I think doctors are demigods. I have butted heads with several over the years, particularly over medications. I'm likely to do so again in the near future.
Rather, I will if I remain with the doctor my husband and I have seen for the past 15 years. My major problem with him? He no longer sees patients in the hospital. Instead the patient is seen by a hospitalist. In my husband's case, over the last 18 months of his life, that translated into at least seven different doctors. The first, and one other, was caring and thorough. My strongest impression with the rest was that they were marking time.

Problems aplenty for doctors AND patients . . .
Posted by Doigotta]]> Sat, 12 Jan 2013 10:03:28 -0600 Arkansas Times
If we want to pay folk on merit then we would have eliminated any public finance, even indirectly, of private insurance and private hospitals in this country. We would have negotiated the merit/price of prescription to or well below what smaller European countries pay now. And merit would be a laugh considering our nation is the most expensive for worst health stats in the developed world... there are a whole lot of demerits these kinds of article ask us to ignore. It's quite likely what these gimmick articles are designed to mislead us about. Neoliberalisim is a beast with many heads, but the same greedy inhumane diet plan wherever we see it. Neoliberals only merit, is profit... not health or care.
Posted by Eureka Springs]]> Sat, 12 Jan 2013 09:40:25 -0600 Arkansas Times
Meanwhile, life expectancy goes up and infant mortality down, by stepping both feet into Canada.

Med student debt so big now that its no longer avarice in a few young docs, but fear of solvency in majority. Except, the debt(medical education bloated bureaucracies know a thing or 2 about manipulating cost accounting) and interest get passed onto to payers in a 'system' based on.......VOLUME. Not curing, volume. "American people think they are buying health, but we are selling health care"
Posted by Diogenes]]> Sat, 12 Jan 2013 09:38:22 -0600 Arkansas Times
Going to see a doctor? Make a list of things to discuss and questions. Use one doctor as your primary care physician and let him/her feed data to others and the others send reports back to him/her. The doctor has a limited time (13 minutes?) to see you so make the most of it. If you are dealing with a member of the greatest generation that tended to not question doctors, go with them and have the list. Don't leave until you get answers. I see mine quarterly and as soon as I get back from an appointment I put a post-it on the calendar next to the date for the next visit.

Another key-run all prescriptions through the same pharmacy, at least for the first time as they have computer programs that look for interactioons. Let the systems work for you and then if you want mail order or go to CheapRx down the street okay but the only way to catch an interaction is to have everything go through the same system and be sure they have your allergies. Don't depend on the insurance companies to catch them. BTW, a drug question-ask a pharmacist, not a doctor. The doctor sees the sales rep pushing the latest and greatest but the pharmacists are trained to look for interactions.
Posted by couldn't be better]]> Sat, 12 Jan 2013 08:01:50 -0600 Arkansas Times