"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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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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New conversation -
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2/2 This natural consequence is amplified by the fact that MBAs & analysts r now running Healhcare, not clinicians.
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You are absolutely correct that fee for svc health care drives over utilization, but it shouldn’t take a rocket scientist or policy wonk to figure out what happens when the financial incentives are turned the other way. 1/2
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Now you have my attention. What does an ACO do for the elderly patient when the revenue stream is based on bonuses for less care?
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We need to fix/improve fee-4-service. With the fragmented nature of our system, it will be hard for quick or even slow shift of payment models. Improve F4S could work as a stepping stone by moving $$ from low to high value care. --->closer to front lines.
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