Business principles are applied to American medicine to an extent found in no other country in the world.
Every procedure, office visit, or hospitalization is assigned a quantitative work value, known as relative value units, that is used to base revenue and salary decisions on.
Harvard physicians Pamela Hartzband and Jerome Groopman looks at how such a fiscal-based system affects medical decision making. The results are predictable.
In general when money is a factor, it “promotes behavior marked by selfishness and lack of collegiality.” In medicine, this leads to doctors becoming “so alienated and angered by the relentless pricing of their day that they wind up having no desire to do more than the minimum required for the financial bottom line.”
Activities that are not reimbursed, such as spending time talking to patients and coordinating care with specialists, are discouraged, since no metric exists that measures “the quality that derives from the communal dimension of medicine.”
As regular readers of this blog know, the business aspect of medicine influences the choices of medical students. “Today’s medical students are being inducted into a culture in which their profession is seen increasingly in financial terms,” the authors write, adding that with the addition of “such pressures as the need to pay off enormous debts, and it is not surprising that students’ choices are dictated by the desire to maximize income and minimize work time.”
What’s the answer? One suggestion is to adopt the patient centered medical home. This concept redirects financial resources to pay for services that are not currently valued, including spending time with patients, managing chronic diseases, and reimbursing for telephone time and other forms of patient communication.
It’s been shown time and again that money influences physician behavior. Changing it to improve the physician-patient experience will require a fundamental reform of how doctors are paid.