Word: fees
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This so-called fee-for-service tradition has contributed to the dysfunction of the U.S. health-care system. Americans buy health care the same way they buy furniture, clothes and food: one item at a time. Physicians bill by the visit; radiologists bill by the X-ray; hospitals bill by the day. That drunken spending has led to the familiar horror-story numbers: a health-care system that gobbles up 16% of gross domestic product, compared with 9% in other industrialized countries, yet leaves the U.S. trailing those countries in such critical metrics as life expectancy and infant mortality...
...that is for consumers and the national debt, it's also turned doctors into fee chasers. More and more of them invest in labs or radiology clinics so they generate revenue not just from the procedures they do themselves but also from the ones they farm out. Others buy state-of-the-art diagnostic hardware and charge state-of-the-art fees to use it. "Focus on your bottom line," urges a brochure for in-office CT-scan machines from one manufacturer. And as long as insurers pay the bills, patients don't ask what things cost. "A colonoscopy used...
Indeed, across the board, costs are going up. And between the millstones of fee-for-service and pressure from insurers to curb all the extra billing, family doctors are being ground into paste. "We've made it systematically as unpleasant to be a PCP as it is to be a primary-school teacher," says Gene Lindsey, president of Atrius Health, a nonprofit alliance of medical providers in Massachusetts. "We're real adept at that...
...Obama singled out Geisinger and Utah's Intermountain Healthcare as examples of organizations that are learning to do things right. He could have cited others too: the Cleveland Clinic, the Mayo Clinic, Kaiser Permanente. What these providers have in common are the creative ways they're doing away with fee-for-service and replacing it with an imaginative mix of systems that cost less, keep patients healthier and make doctors happier. "We need a transition to rewarding the actual value of care," says Dr. Elliott Fisher, director of population health and policy at the Dartmouth Institute. "For now, our payment...
...order to have a fixed route from Point A to Point B, go into the City of Cambridge, and charge a fee, you need a jitney license,” said Scali. Curreri said that Entertainment Tours had a bus license from the state, but received a desist order from the city of Cambridge...