"Performance-based pay...is irrelevant to the complexities and professionalism of good doctoring and other human services like education."
https://www.statnews.com/2018/01/30/pay-for-performance-doctors-hospitals/ … via @statnews
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How? Well, we have to at least not penalize that kind of work/innovation. Which still means learning ways to move away from fee for service which does that opposite. This is a matter of iteration, not simply testing and rejecting, pay for value approaches (like capitation, ACOs).
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Analogy: For a decade, the effort to bring genomics to the bedside failed to produce much evidence of value. But we supported innovation and are now in the flowering of remarkable breakthroughs. We likewise need to support lots of innovation in payment methods and delivery.
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Key is 2 things you said: groups of clinicians and iteration. Both point to focusing on well-defined medical conditions first, and then expanding towards capitation. Much harder to iterate on an ACO than on a bundle. Physician-led ACOs/Medical Homes picking bundles is promising.
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Hospital-led ACOs are too complicated an entity and about as useful as Pharma-led ACOs. Doctors within them are inadequately empowered to deliver the improvement we want; the larger the team, the more the free-riding and lack of responsibility.
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Is the hospital led vs physician led difference that firmly established? Can you point me to the best research?
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I was sharing my intuition on physician-led ACOs—
@Farzad_MD is the man on this -
Great. Thanks-was afraid I had missed something and would need to reevaluate some of my research
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