Word: systemically
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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...
...there are ways to fix what ails the docs - and repair the health-care system in the process. In the rolling hills of central Pennsylvania, the Geisinger Health System is trying something different. The 726 physicians and 257 residents and fellows who work there don't do piecework. They are paid a salary - benchmarked against the national average - plus potential bonuses based on how well their patients do under their care. One result is that Geisinger is able to hang on to its PCPs while other hospitals are losing theirs. Another is that Geisinger makes money...
...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 system is getting in the way." (See the Cleveland Clinic's smarter...
Less Is Much More In the years since the reviled health-maintenance organizations (HMOs) were at their peak, all manner of fixes have been proposed to the health-care system, from small tweaks to wholesale overhauls. There's pay-for-performance: compensation depending on doctors' success in keeping costs down and getting patients well. There's episode care: a fixed price for a procedure like a heart bypass that covers everything from pre-op to surgery to full recuperation. Most broadly, there's global care, which provides access to a diverse team of caregivers who cover all of a patient...
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...