Malpractice Claims Are Only the Beginning of Physicians' Worries...

Just a few days ago (and not long after the announcement of a possible 5.1% cut in Medicare payments to physicians was announced), the Institute of Medicine released a report calling for an across the board reduction in Medicare payments to providers and the creation of a fund that pays "bonuses" for strong performances. The committee chair and a professor of health care at the University of California, San Francisco, Steven A. Schroeder, offered his support of the proposal when he stated that "Medicare beneficiaries are not getting the highest possible quality of care because the program's payment system encourages volume rather than efficiency and quality." The comittee acknowledged, however, that there is little data available suggesting that pay-for-performance systems have a positive impact on patient care.

In and of itself, this proposal seems like a sound, logical solution to the so-called problem. The logic goes something like this: (1) The prospect of the receipt of a monetary benefit encourages all human beings to perform at their highest levels. (2) Providers are human beings. (3) Therefore, offering providers a monetary benefit will encourage them to perform at their highest levels.

This logic may not take into consideration the current climate, however. Given that providers are already under a substantial amount of pressure to avoid malpractice suits and already face another cut to their Medicare payments, such quality measures accompanied by an across the board cut may only serve to drive an even stronger wedge between those providers who care about patients and patients who deeply desire to have a good relationship with those responsible for providing their medical care.

When proceeding with reforms, care should be taken to ensure that the divide between physicians and patients is not strengthened and that changes made do not lead to increased resentment between the parties.