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> We pay most doctors and hospitals based on patient outcomes, not fee-for-service. Wouldn't doctors be incentivized by this fee structure to walk away from d

> We pay most doctors and hospitals based on patient outcomes, not fee-for-service. Wouldn't doctors be incentivized by this fee structure to walk away from difficult cases, where a treatment is risky but is the last hope for the patient, if they won't be paid for the likely bad outcome?

dmcgee 5y ago
Good observation. This already happens within certain hospital systems, based on "protecting the numbers". So for instance a surgeon not wanting to take on a patient because it is a likely mortality on their record.
aquaphile 5y ago
Good question, and thank you for asking it. The short answer is No. We have “escape” codes to make sure the doctor is not penalized. For example, if there is a risk of embolism or if there is an aneurysm complication during surgery, then the payment reverts to a fee for service. The point is to ensure patient safety and high quality of care, not penalize the doctor for events not in their control. If the care being sought is highly experimental or risky, we work with physicians to determine if there are centers of excellence that may provide higher quality of care.
throwawayboise 5y ago
Any fee structure will have certain incentives; it's unavoidable. The trick is to try to find incentives for the providers that also align with positive results for the patients. Having the actual results align with the intended ones is easier said than done, as anyone who has ever tried to design and administer any kind of measurement-based compensation or bonus plan will tell you.
- mjamilkowski 5y ago
  Yes you are right - And we recognize this as part of our outreach and contract development efforts. Our collaboration seems to be working and we are getting great reaction from physicians. We believe in a simple approach to keep it understandable and easy to administer to build that relationship
- lotsofpulp 5y ago
  > The trick is to try to find incentives for the providers that also align with positive results for the patients. That part is easy. The hard part is aligning providers, patients, and the payers, since the patients cannot afford to align the providers with themselves. Enter politics, because you are now distributing limited healthcare resources with demand far greater than supply, meaning you have to either pony up more from the payers and/or ration various quality of healthcare to various populations, per their political power.

dmcgee 5y ago

Good observation. This already happens within certain hospital systems, based on "protecting the numbers". So for instance a surgeon not wanting to take on a patient because it is a likely mortality on their record.

aquaphile 5y ago

Good question, and thank you for asking it. The short answer is No. We have “escape” codes to make sure the doctor is not penalized. For example, if there is a risk of embolism or if there is an aneurysm complication during surgery, then the payment reverts to a fee for service. The point is to ensure patient safety and high quality of care, not penalize the doctor for events not in their control. If the care being sought is highly experimental or risky, we work with physicians to determine if there are centers of excellence that may provide higher quality of care.

throwawayboise 5y ago

Any fee structure will have certain incentives; it's unavoidable. The trick is to try to find incentives for the providers that also align with positive results for the patients. Having the actual results align with the intended ones is easier said than done, as anyone who has ever tried to design and administer any kind of measurement-based compensation or bonus plan will tell you.

mjamilkowski 5y ago
Yes you are right - And we recognize this as part of our outreach and contract development efforts. Our collaboration seems to be working and we are getting great reaction from physicians. We believe in a simple approach to keep it understandable and easy to administer to build that relationship
lotsofpulp 5y ago
> The trick is to try to find incentives for the providers that also align with positive results for the patients. That part is easy. The hard part is aligning providers, patients, and the payers, since the patients cannot afford to align the providers with themselves. Enter politics, because you are now distributing limited healthcare resources with demand far greater than supply, meaning you have to either pony up more from the payers and/or ration various quality of healthcare to various populations, per their political power.