Word: carefuls
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HOUSE TRI-COMMITTEE This alliance of three committees released a draft bill June 19, including a public plan financed by premiums. It would initially reimburse health-care providers using Medicare's lower rates...
...major problem with American health care today is what policy experts call "perverse incentives." Doctors and hospitals bill insurers for every individual service - every office visit, MRI or hour of operating-room time - a "fee for service" model that drives health-care inflation by rewarding providers who order potentially unnecessary tests, perform potentially unnecessary surgeries and even make mistakes. A hospital readmission caused by avoidable complications just means more billable expenses...
...contrast, Prometheus, funded by a $6 million grant from the Robert Wood Johnson Foundation, calculates compensation for hospitals and doctors based not on the specific treatments a patient receives but on the care a patient should receive "per episode." (Prometheus's calculation model is an open-source program that is already garnering interest from insurers in Minnesota, Pennsylvania and elsewhere...
...incentive for the heart patient's doctor to spend less than $20,750 is that he gets to keep a portion of the difference (assuming that the patient was managed properly and happy with the outcome). And the best way to keep costs low is to offer the best care: If the doctor is negligent in monitoring the patient's condition or fails to counsel the patient fully about proper diet and exercise, that patient could have a heart attack - requiring more treatments - and the doctor would take a financial hit. "The more defects you prevent, the more money...
...simple idea that makes sense in theory. And yet no patient wants to believe that his own doctor is this focused on the bottom line. While data indicate that up to 30% of U.S. health-care spending is for unneeded and even dangerous treatments, the truth is that most doctors aren't purposely ordering up tests or treatments just for the cash. "The system is asking them to do what's right for a system that lives off of excess, as opposed to what's right for the patient," says De Brantes. See pictures from an X-ray studio...