Paying doctors by the hour

“Pay by the hour is the most difficult method to game,” says Half Sigma. Makes sense, but without any productivity incentive, appointment shortages may become more dire as the longer visits will fill more physician schedules.

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Anonymous
Hourly rates are the way nearly all professionals are paid, and are entirely appropriate and workable for physicians. I don’t think that backlogs would get worse. If the physician’s response is to slow down, care would likely be more efficient. Think of all the procedures and studies that could be saved by the simple expedient of spending time with people to get the history, do an exam, make a clinical diagnosis, and taking the time to listen and provide reassurance. The reduction in patient visits to second and third doctors due to lack of reassurance from cattle drive style care would alone open up capacity. Massive billing fraud would be easier to catch and could be monitored by third parties less intrusively.
Most importantly, from the utilization point of view, the small portion of doctor who guide their practice by their own financial benefit, would have to order a 10,000 dollar procedure to earn themselves a couple hundred. They would be paid the same for the days work wether they ordered an abdominal CT for Mrs. Jones belly pain, or listened to Mrs. Jone’s belly aches.
You could be more financially productive by:
Working more hours to see more patients.
Working more hours providing more thorough clinical services to the same number of patients.
Working to increase your value by improving your skills, the quality or your care, and customer service so that you can charge a higher hourly rate.
Sounds like a great alignment of the individual practitioners incentives with the patient’s and public’s interests! Insurance companies could do like many dental plans do now: Declare what rate they will pay and it is between the patient and the doctor whether he will take that or the patient must pay the difference.
Anonymous
“If the physician’s response is to slow down, care would likely be more efficient.”
What? Where in the world are you pulling this from? The only thing holding the current system up is doctors busting their asses to squeeze people into 15 minute consults and juggling 8 different patients while doing so. Being paid by the hour actually sounds pretty sweet, but I don’t feel like going through the hassle of changing over and then changing back 6 months later when American medicine comes grinding to a halt as physician productivity is suddenly cut in half.
Anonymous
Just try hiring a cab at alley rate.

Paying doctors by the hour

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