Thursday, December 27, 2007

The Ultimate Efficiency

I am constantly amazed at the dizzying heights hospital and insurance bureaucrats will take physicians, all in the name of profit.

In the old days, I could ask my patients questions, take a thorough history and physical, and order tests that made sense to the problem(s) at hand. In short, I could use my brain and patients benefited.

Now, I get paid based on performance. Document the E&M parameters, fill in the necessary blanks, or else. Paint-by-numbers, I called it. Pay for performance became the new Medicare standard creating a heretofore unprecedented bureaucratic morass in 2007. Entire practice patterns were shifted and protocols implemented to maximize Medicare reimbursements for hospitals and physician practices, even if it deleteriously affected the doctor-patient visit. Just ask the questions, dammit, to make sure you get paid the maximum amount and to make sure we look good on hospital rankings!

But that, my friends and colleagues, is not enough. Bureaucrats demand more. Much, much more.

Now, my fellow physicians, we must concern ourselves with efficiency!

And yes, we must create more measures of our efficiency! After all, how else will our "customers" be able to compare us and our "efficiency index?" These business interests (one who also holds an associate editor position at the New England Journal of Medicine in which the discussed editorial aired) hold the precious financial assets, so they will demand it! They want "performance" and "efficiency," all rolled up into one! And if we don't determine our own efficiency measures, well, you can be sure that those lovely "customers" who require our physician services will develop the measures for us! After all, they demand complete and utter efficiency at all times: efficient money collection, efficient returns on their investment, and, in the case of the insurance industry, efficient denial patterns for reimbursements. Efficient, efficient, efficient.

But in the end, isn't the ultimate efficiency less bureaucracy?


Arnold Milstein, M.D., M.P.H., and Thomas H. Lee, M.D. "Comparing Physicians on Efficiency." N Engl J Med 357:2649-2652.

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