Comments on: Should doctors competitively bid for Medicare rates?

By: Doc Stone

Doc Stone — Wed, 10 Jun 2009 03:15:22 +0000

I agree wholeheartedly with the post by Hicks. With some programs now such as Medicaid we see the result of paying the lowest rate which a minimum acceptable number of practitioners will accept: a race to the bottom in quality of care by flourishing and profitable medicaid mills–even while sound quality practitioners can’t afford to participate.

A better idea for “competetive bidding”. Allow full and free balance billing in the public programs. Let physicians balance bill to their full fee or a part thereof according to their own choice on a case by case basis. Some phsicians will “bid” for the Medicare/Medicaid market by accepting the rate the state pays as full fee. Others will accept it on a case by case basis as an act of charity. The patients themselves can effectively bid for how much of a premium value to place on incremental quality and service in their choice of how much balance billing they will accept when they seek care. Freedom will solve a lot of problems if we will just try it.

By: David Block MD, PhD

David Block MD, PhD — Wed, 10 Jun 2009 01:50:09 +0000

Folks, please correct me if I’m wrong. But in a TRUE auction, you have multiple, independent, free agents, exchanging a commonly denominated currency, in a generally non-emergent situation, where there are no artificial constraints (i.e., agents can enter or leave the market place). Is that how you would characterize a typical clinical situation? Or are you talking about doctors forming labor organizations and ‘bidding’ on contracts for a certain locale over a specific epoch? I guess I don’t see why this isn’t the equivalent of an HMO where the doctor (and hospital) take all the risk since they can’t legally walk away, nor let their practices lapse. (I don’t say ‘ethically walk away’ since morality has nothing to do with it, obviously).

Why not use an approach that works well for academe, the armed forces, politicians, the clergy, and management in general? Pay doctors – all doctors, every doctor, regardless of specialty – enough to make them feel appreciated, special, insulated from doubt and fear of the market, and as envied by the community as Jay-Z. Make it tough to reach that height, easy to fall (tougher and easier than now). Reward the practice of medicine as a calling, and not an economic convenience. Reward for Being, not for Doing. If you really are a doctor, you’ll do what a doctor should do. If you are rewarded for doing what a doctor should do, you never become one.

By: Web Media Daily - Link Edition Tuesday June 9, 2009 | Reinventing Yourself...

Wed, 10 Jun 2009 00:35:30 +0000

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By: Karl J. Edelmann MD, MBA, CAQ-G, FAAFP

Karl J. Edelmann MD, MBA, CAQ-G, FAAFP — Tue, 09 Jun 2009 23:03:05 +0000

P.S. Sorry for the typos. Too used to autocorrect :-;

By: Karl J. Edelmann MD, MBA, CAQ-G, FAAFP

Karl J. Edelmann MD, MBA, CAQ-G, FAAFP — Tue, 09 Jun 2009 23:01:07 +0000

Competitive bidding already occurs through IPA’s and IPO’s although most don’t realize that the process is occuring. When the leadership of a group negotiates on behalf of their members, competitive bidding is already occuring. The challenge will be to extend it regionally or nationally. I remember when we were initially discussing DRG’s back in the 80’s and trying to come up with a reasonable formula that would work regionally (not even natioanlly) ad it was a nightmare that grew into a huge mess that we still deal with today.
Reducing the individual physician to bidding on reimbursement for care will lead to either reduced access, a stampede to cash only care, or a fair number of well trained professionals leaving the practice of medicine for other environs becasue they don’t want to deal with the nonmedical hassles. The headline on the recent AMNews showing that the current paperwork required by health insurers costs $70,000 per physician annually is probably an underestimation in my experience and will only get worse with a single payor system or a national “super-carrier” of medicla insurance.

By: Bad Medicine, Good Solutions

Bad Medicine, Good Solutions — Tue, 09 Jun 2009 21:47:40 +0000

How would this prevent the bankrupting of CMS? If anything this will increase costs. The few groups that will bite on this land mine in regions will not be able to accomodate all the medicare needs. As a result the overflow will feed into the ER, as you can assume at least one hospital will still be taking medicare. Increase ER usage equates to increased costs. This would be good in the sense CMS would be releasing some of its tallons in the medical industry that it currently exhibits with its nationwide price fixing.

By: Happy Hospitalist

Happy Hospitalist — Tue, 09 Jun 2009 19:56:05 +0000

That's interesting, since I suggested that many months ago, on several occasions here and here in several different forms. Personally, I like the bundled care option, market based bidding which takes care of the waste AND regional over supply and under supply at the same time and prevents the bankrupting of the Medicare National Bank.

By: Aaron B. Hicks

Aaron B. Hicks — Tue, 09 Jun 2009 15:45:14 +0000

When asking whether doctors should be subjected to competitive bidding as a means of cost control, one must consider the types of behaviors such a policy would incentivize. Paying doctors less for their services creates an incentive for providing more service over shorter intervals. Unless doctors are rewarded for value, those adept at countering low reimbursement with high volume will out compete other physicians in light of an artificially low reimbursement rate. So, when it comes to developing policy for reimbursements, we need to answer this question: do we want quantity or quality? (Studies show that quantity doesn’t result in better health outcomes…)