For the first time, doctors have been found to be making more money by ordering more procedures rather than for providing service to more patients. The results of recent UCLA research, which surprised the team behind the study, have led them to suspect that the pay-for-service system may encourage behavior that is not in the best interest of patients.
“The difference in earnings was highly significant,” Jonathan Bergman, an assistant professor of urology and family medicine at the David Geffen School of Medicine at UCLA and a urologist and bioethicist at the Greater Los Angeles Veterans’ Health Administration, told The Speaker. “This resulted from higher services offered per beneficiary.”
The findings, the researchers reported, were “very surprising.” It was the first time that higher-earning clinicians had made more money because they had ordered more services and procedures rather than because they had seen more patients.
The team examined Medicare bills from the 2012 calendar year and compared this information with amounts paid to clinicians.
“What people can learn is that fee-for-service may not be the most reasonable way to pay doctors. Also, that charges outpace payments by three is like listing $3 as the supposed price of a $1 Coke,” Bergman told us.
Bergman also commented for a press release on some of the possible flaws in Medicare policy.
“Medicare spending is the biggest factor crowding out investment in all other social priorities,” said Bergman.
“Perhaps it would make more sense to reimburse clinicians for providing high quality care, or for treating more patients. There probably shouldn’t be such wide variation in services for patients being treated for the same conditions.
“[The] findings suggest that the current health care reimbursement model–fee-for-service–may not be creating the correct incentives for clinicians to keep their patients healthy. Fee-for-service may not be the most reasonable way to reimburse physicians.”
In order to more conclusively answer whether the fee-for-service system was flawed, Bergman said, more research was needed–particularly an assessment of whether treatment outcomes for patients differed for those who had more or less services ordered. This research could also show how best to use resources to maximize medical benefits for people, he added.
“The most important takeaway is that it is hard to evaluate appropriate compensation for doctors, much like it is for teachers,” Bergman told us. “The answer isn’t to rely solely on services done, which is as problematic as using test scores to identify the best teachers.”
The letter on the research was published in the journal JAMA Internal Medicine.
By Cheryl Bretton