FROM THE BLOGOSPHERE
DAWN OF THE PLANET OF
THE VALUE BASED
James Patrick Murphy, MD, MMM
an, crossing medicine’s threshold felt like
coming home. Now in this modern medical
renaissance, home is not necessarily where
the heart is. Home is now inhabited by impostors masquerading as quality and value.
I
t is the dawn of a new era.
Many cogs are now required to turn the
wheels of our nation’s juggernaut health
care industry. Physicians, historically the
driving force in medicine, are not generally
the “cog” type. This juxtaposition can have
unhealthy consequences for all of us.
In his August Wall Street Journal article
“Why Doctors Are Sick of Their Profession,” Dr. Sandeep Jauhar documented the
pathology in our nation’s medical history.
And while I agree with the good doctor’s
diagnosis, I am not as comfortable with his
treatment plan, which includes:
1. “giving rewards for patient satisfaction”
2. “replace the current fee-for-service
system with payment methods such
as bundled payment, in which doctors
on a case are paid a lump sum to divide
among themselves”
3. “pay for performance, which offers
incentives for good health outcomes.”
At first glance, Dr. Jauhar’s suggestions
would appear to be reasonable measures.
But employing such metrics may not sit
well with our current physician workforce
for a number of valid reasons.
In days past, the medical profession attracted highly intelligent practical dreamers in search of a career that allowed and
rewarded unfettered blending of art and
science; answering a “calling” that revered
the heartfelt patient-physician relationship.
If you were a “Renaissance man” or wom-
In days past, creativity and problem
solving were vital to success in health care.
Now strict adherence to guidelines, meeting
quotas, and saving money for third party payers are paramount. Now the “rough
spots” in the delivery line -physicians who
view patients as individuals as opposed to
populations – are being made smooth or
else discarded.
Given a metric that determines their “bonus,” worker bees will instinctively aim for
that mark. So if earning money to send their
kids to college depends on getting a “five
star” customer satisfaction rating, then expect health care professionals to make flashing a salesman’s smile the priority. Running
a clinic on time will become more important
than taking time to comfort that patient
whose problem unexpectedly deserves more
attention than the automated schedule