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Republicans worry that a public plan would amount to a "government takeover" of health care that would bureaucratize the doctor-patient relationship...
...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...
Taking the congestive-heart-failure example, here's how the payment scheme would work: A slightly overweight 60-year-old heart-failure patient comes in with coronary-artery disease and acid-reflux disease. According to a Prometheus algorithm, this patient should cost $20,750 a year to treat - including office visits, medications, blood-pressure monitoring and an allowance for complications. The 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...
...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...
Still, overhauling the current health-payment system has other pitfalls. Back in 1983, Medicare initiated a similar plan, bundling payments for hospital stays, but the program acquired the unfortunate label "quicker but sicker." Since hospitals were paid a certain amount of money for each patient no matter how long they stayed, many patients were discharged sooner than was prudent, which transferred the burden of care onto nursing homes and created a "mini-industry of readmissions," according to Gail Wilensky, a former head of Medicare. "Redesigning the reimbursement system is not for the faint of heart," says Wilensky. "This...