Respected economist Uwe Reinhardt has been penning a series of NY Times blog entries explaining why American health care is so expensive.
In his latest entry, he takes on the physician payment system, writing that “studies have shown that physicians are not impervious to the financial incentives inherent in fee-for-service payments,” and that “physicians who have a direct financial interest in the use of imaging services, like CAT scans or M.R.I. scans, recommend far more such services for their patients than do physicians without such financial interest.”
No argument from me. The physician payment system needs to be fundamentally reformed if we hope to control health spending.
What Mr. Reinhardt fails to mention is the Resource Based Relative Value System Update Committee (RUC), who are responsible for the heavy skew towards expensive procedure-based care. Medicare bases its prices on the recommendations from the RUC, a group that is dominated by specialists. It is no wonder they are loathe to appropriately pay primary care medicine at the expense of specialist payments.
Internist Roy Poses wonders whether Mr. Reinhardt’s unpublicized associations with health insurer Amerigroup and medical device maker Boston Scientific, both companies that benefit from the status quo in the physician payment system, led to this glaring omission.
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- Health care reform analysis from a former insurance and hospital executive
- Why Americans fear radical health care reform
- Op-ed: Doctors’ pay cuts save little in health costs
- Conflict of interest and Steven Nissen, the next potental head of the FDA
{ 4 comments }
The more I read about this Resource Based Relative Value System Update Committee the more I think greater transparency is needed.
We don’t hesitate to squewer this fellow for his associations, but what are the disclosures from this committee?
I don’t share Kevin’s admiration for Uwe Reinhardt.
The main thrust of Reinhardt’s article is that EMRs will afford “transparency” (whatever happened to “privacy”?); and the authorities will be able to calculate a physician’s ratio of dollars spent to the level of sickness treated.
Once again Reinhardt has seen the future: Soviet farming.
Shocking?
Not really. If one were to follow an “expert’s” paper trail — their world-view can be determined, pretty quickly.
Erza Klein? Pro-government.
Uwe? Pro-government.
Commonwealth Fund? C’mon .. that’s so obvious, Vanna White doesn’t even need to turn the letter “L”.
I doubt Uwe Reindhardt has much of a problem of conflict of interest. If you read his posts and watch his interviews you will find that he goes far to try to keep objective in his points. The very statements he makes are game changing and will probably be to dissadvantage of any company or organization.
If you read other articles by Dr. Reinhardt, you will find that he complains about the insurance’s companies lack of transparency in transfer prices to Physicians and Hospitals, even that he approached somebody he knew from an insurer and the person didn’t want to answer; he posted talked about this in congress, which I bet the insurance industry doesn’t want to be heard.
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