Doctor is in by Dr. Adil Manzoor OP/ED
I hate to be that guy, but we are going to be starting this article off with saddening news. The United States of America has the highest percentage of GDP spent on healthcare among developed countries, standing at almost 18%. But that’s not the saddening part. Despite spending more on healthcare, the US lags behind other developed countries in virtually every aspect of healthcare. What this means in very simple terms is that we spend far more for far less. Now, that’s sad.
One problem we have never really figured out how to solve is how to reduce the cost of healthcare. Well, that’s what I used to think. The truth, however, is that we have figured out a way to solve this problem; we are just not implementing it. What way am I talking about? Ridding the fee for service payment model for good.
The fee for service (FFS) model is the most widely used payment method of healthcare in the US. It is simply paying healthcare providers based on the number of services they render. No bundle payments in this model. Each test, procedure, or any other form of treatment is charged individually. Nothing seems sketchy about this on first viewing, but you just wait till we take a second look at it. This model of payment rewards healthcare providers based on the number of services they render, irrespective of the outcome. Reread this and think of what the problem may be. Anything?
Okay, let me just spell it out. This model pays based on the number of services rendered, regardless of the impact on the patient’s health. Imagine it this way. A patient goes to a physician with a medical ailment that requires a simple non-surgical procedure. But there is another way of treating the medical ailment – a surgical procedure and several other tests. The simple non-surgical procedure costs less than the surgical procedure and the tests but gives the same effect. Let me then ask you a question, which do you think many physicians will prefer?
You may be seeing my problem with the fee for service model now. With this model, many physicians take the way that will give them more money. This model of payment allows doctors to take unnecessary tests and measures in a bid to increase their profits. The tests and procedures are most likely not harming the patients in any way whatsoever, but they are simply useless. The patients don’t need them, but doctors take these tests because they can get more money this way.
Let me pitch a genius suggestion to you. What do you think of a system where doctors are paid based on the value of the service they render and not the quantity? You are thinking ‘there’s nothing genius about this, it seems basic,’ and you are absolutely correct – it is basic! The Affordable Care Act signed into law years ago supports this. That Act was targeted towards doctors focusing on increasing value rather than just the volume of healthcare services, but what has changed? Nothing. It’s been ten years, and not a single thing has changed. And this right here is what is wrong with the healthcare system.
The reason our healthcare is in a mess as a country is that the providers of that healthcare care more about money than actually providing healthcare. There is no other explanation, because how else can you explain choosing a long way over a shorter and equally effective one simply because you want to make more profits? And I’m not just making things up.
A study conducted in 2010 showed that non-surgical treatments are not only as effective, but also less risky than surgical procedures for patients with a herniated disc (provided there is no nerve compression, sensory impairment, or loss of motor skills). In spite of this, the frequency of surgical interventions has not reduced.
Let me interpret it for you this way – doctors are willing to take on a riskier procedure as long as it means they can get more money from it. And we wonder where the problem lies in our healthcare system. Not only that. Several studies have also shown that physicians frequently perform knee arthroscopies when physical therapy alone will suffice. You know the reason why? Because they’ll get more money from it. This is sick.
This model of payment is obviously not working. We spend much more on healthcare than other developed countries because things like this exist in our healthcare system. The fee for service model is only causing uneven care, price inflation, and excessive services. You and I are probably thinking the same thing – if it’s not working, then why do we still have it? The answer will shock you.
Although alternatives have begun to spring up across the nation, like the Accountable Care Organizations (ACOs), Clinically Integrated Networks (CINs), and the Patient-Centered Medical Homes (PCMHs), health practitioners don’t want to hop off this model because of the ‘fear of the unknown.’ Many of them believe that although the FFS model is failing, we should stick to it because we are familiar with it.
My theory about healthcare providers caring more about profits is not looking too crazy now, is it? If we leave it to these guys to keep making financial decisions for us, our healthcare is only going to get worse. And with the state it is in right now, I can’t even begin to imagine what worse will look like.
It just occurred to me that I haven’t given the most definitive answer to the topic question, so I’ll say this now – it is time to finally say goodbye to the fee for service payment model in healthcare. We have coped with this long enough, but it’s time for it to leave, especially now that the economic effects of this pandemic are starting to tell off on many.
It’s time to start paying for performance and not just volume. Do you know what Direct Primary Care is? It is the system that I believe will change primary care medicine and reduce cost. This, we will talk about in our next week’s article.
Dr. Adil Manzoor DO is Board Certified Internist & Board Eligible Pediatrician, whom works as a Hospitalist, and Emergency Room Physician. He is also the current President of Garden State Street Medicine, a non-profit organization whose sole purpose is to provide free preventive & acute urgent care services for the homeless. He’s also the co-founder of his own unique medical practice Mobile Medicine NJ.
References:
· https://prognocis.com/what-is-fee-for-service-in-healthcare/
· https://www.healthleadersmedia.com/finance/fee-service-model-least-effective-outcomes-and-costs
· https://amp.theatlantic.com/amp/article/256755/
· https://www.forbes.com/sites/robertpearl/2017/09/25/fee-for-service-addiction/amp/
· https://www.statista.com/statistics/184968/us-health-expenditure-as-percent-of-gdp-since-1960/
