“Two or three years ago, 100 percent of cardiologist compensation was base pay,” he said. “Increasingly, that has shifted.”I find this concept of paying doctors "based on outcomes" interesting but also troubling.
Administrative time and performance incentives are factored in when considering the total take-home pay of a cardiologist. While most of a cardiologist’s income still derives from a base salary, Mr. Palazzo predicts that will change.
“As accountable care moves along, it could go to as much as 50-50 three to five years from now, where 50 percent is paid based on outcomes,” he said.
If you do an echo really well and take a million measurements when others just do the bare minimum - what's the outcome? If you spend four hours with a patient when others spend 15 minutes a patient, what's the outcome? If a patient has chest pain, gets stented, goes home the next day, but an expensive drug eluting stent is used where a bare metal stent would do, what's the outcome? If the patient dies despite doing everything correctly duing a three-week hospital stay, what's the outcome? If you order a test because the family insists, what's the outcome?
What "outcomes" are hospitals taking about? Outcomes for the patient, doctor, or hospitals themselves? Are physician outcomes going to be based on "quality metrics" (like open encounters, performance measures completed and percentage of generic drugs prescribed), quantity of patients seen per week who didn't die, "Best Doctor" status, or corporate politics?
I wonder if a "good outcome" will really mean nothing more taking in more money than you spent on providing patient care.
Does anyone really have a clue what "outcome" fudge factor means?
I suspect not.
More likely what will evolve in my view, is that doctors' productivity bonuses will disappear in favor of straight salary with their income docked if simple, easy-to-measure "quality measure" endpoints are not met.
Unfortunately, just because endpoints are easy to measure, does not mean they make a difference for our patients.