February 20th, 2009

Writes Pauline Chen, M.D. in a piece for the New York Times:

I met up recently with a friend who is a primary care physician. His practice has just signed a contract with the state’s largest insurer that reimburses not according to the traditional fee-for-service, which pays doctors a set price for each visit, test or procedure they do, but according to a newer standard known as “pay-for-performance.” The insurance company will give his practice a budget for each patient; the doctors in the practice can earn more by cutting costs and by meeting certain quality goals, like controlling blood sugar or high blood pressure in patients.

I asked my friend if he was happy about the new contract.

“I guess so,” he replied with some hesitation. “I’m not sure how else we are going to stop spiraling health care costs.” But then he added, “I do worry about how this will affect my relationship with patients. If my patient comes in with a headache and wants a CAT scan, but I don’t order it because I think it’s not medically indicated, will that patient think I’m just trying to save money?”

Read Dr. Chen’s in-depth examination of the difference between the two policies, and how she believes it could affect healthcare and physician-patient relationships, at the Times.