Word: making
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Dates: during 2000-2009
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...whole lot shorter. Only 3 out of 10 doctors in the U.S. now are PCPs, compared with 5 out of 10 elsewhere in the world. Those family physicians who remain find themselves in a constant money chase, meeting their monthly nut with the help of the revenue they make by prescribing tests - X-rays, CT scans, EKGs - that may or may not be strictly necessary but generate a lot of separate billing. (See 10 health-care-reform...
...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 system is getting in the way." (See the Cleveland Clinic's smarter approach to health care...
Family physicians in the Geisinger system, like family physicians everywhere, make less money than specialists - at first. To narrow the gap, the specialists subsidize the PCPs, keeping the family practitioners happy without taking too big a bite from the orthopedists and cardiologists. "I couldn't recruit if I didn't do that," says Dr. Glenn Steele, Geisinger's CEO. "We don't want our family doctors setting up their own radiology clinics...
...years and mandating global care statewide. Similar plans are ramping up in Minnesota and Wisconsin. "We're going to do this incrementally," says JudyAnn Bigby, Massachusetts' secretary of health and human services. "We want to increase pay-for-performance first and episode payments next." Is five years enough to make the transition entirely? Bigby concedes she doesn't know. "No one's ever done this," she admits...
Overhauling fee-for-service may well make medicine less lucrative for some practitioners. But it would give others a new opportunity to practice medicine in an almost forgotten way: getting to know their patients and keeping them healthy so they can avoid a surgeon or a hospital. "It's a chance for a primary-care doctor to be a hero again," says Dr. Thomas Graf, chairman of Geisinger's community-practice team. That's not the stuff of AA bond ratings or billion-dollar revenue streams, but it just might be worth more than both...