Category Archives: Payment Reform

Pay-for-Performance Programs Ignore True Human Motivators

brainstormsI often listen to books on CD during long trips in the car. They’re a great way to catch up on reading and provide the added bonus of letting me avoid the mind-numbing “hit list” of pop tunes on the radio.

After a trip that flew by while I laughed to Tina Fey’s Bossypants (worthy of a future post if I can figure out to link it to health care), I tried another nonfiction selection from my local library: Drive by Daniel Pink. Pink worked as an aide to Secretary of Labor Robert Reich, and from 1995 to 1997, he was chief speechwriter for VP Al Gore. He graduated from Yale Law School and has written five best-selling management books. His 2009 TED talk on “the puzzle of motivation” is one of the 10 most-watched.

Continue reading Pay-for-Performance Programs Ignore True Human Motivators

Yale’s I-CARE Engages Residents, Faculty on Costs in Friendly Competition

teaching_values_projectBy Robert Fogerty, MD

Residency is like the adolescence of medical training. Residents are testing boundaries, learning their limits, and developing their diagnostic and therapeutic skills. Much like a young bear learning to fish, residents learn by doing under the close supervision of a faculty physician. Mama bear won’t let her cub starve and faculty won’t let the residents cause harm. When given the chance, however, residents will push those boundaries to the limits in an attempt to best each other. They are, inherently, competitive creatures. Much like the proud bear with a big salmon, the resident with the rarest diagnosis or the most abnormal lab value becomes the alpha doctor. At Yale School of Medicine, we leverage this competitive atmosphere to engage residents in learning and education.

Continue reading Yale’s I-CARE Engages Residents, Faculty on Costs in Friendly Competition

Bundled Payments: Are You Ready for Change?

brainstormsBy Joanne Conroy, MD

No one really loves change. When the change has an unclear impact, we often resist because of the fear of the unknown. Our resistance runs the emotional gamut from “Life is complex enough; why change what is already working?” to feeling actively threatened from a personal security or financial perspective. We can manage the anxiety by educating ourselves and developing a change strategy to embrace the emotional and operational impact of the change. We do this all the time in our personal lives, yet, in our professional lives, we often adopt an “ostrich mentality.” Choosing not to prepare for change leads to greater uncertainty and fear.

For teaching hospitals, the case in point is the shift in payment models from fee-for-service to alternative or bundled payments.

Continue reading Bundled Payments: Are You Ready for Change?

Brave New World: How Health Care Will Survive in a Post Fee-for-Service World

By Melinda Rogers

When Vivian Lee, MD, needed to find innovative tactics to reduce costs in the health care system, she looked to an airbag manufacturing plant for inspiration.

The idea seemed unorthodox at first. After all, what could a factory that manufactures airbags for cars have in common with a health care system? But Lee, Senior Vice President for Health Sciences at the University of Utah, Dean of the University’s School of Medicine, and CEO of University of Utah Health Care, was willing to think outside the box.

Continue reading Brave New World: How Health Care Will Survive in a Post Fee-for-Service World

Health Insurance Exchanges and the Affordable Care Act: What To Expect on October 1

By Henry J. Aaron

Originally posted on August 7, 2013

You have probably heard the classic definition of the Yiddish word “chutzpah”—it defines the behavior of the youngster on trial for killing both his parents who pleads for mercy because he is an orphan. The current behavior of the Republican party with respect to implementation of the Affordable Care Act (a.k.a. Obamacare) fits that definition pretty well. Republicans are vociferously predicting that implementation of the that law will fail and simultaneously doing all they can to produce that outcome. They seek to stop spending to implement the law. Continue reading Health Insurance Exchanges and the Affordable Care Act: What To Expect on October 1

Another Attempt to Show the RUC Behind the Curtain

By Roy Poses, MD

Originally posted on Health Care Renewal on Monday, July 8, 2013

In 2007, readers of the Annals of Internal Medicine could read part of the solution to a great medical mystery.(1) For years, health care costs in the US had been levitating faster than inflation, without producing any noticeable positive effect on patients. Many possible reasons were proposed, but as the problem continued to worsen, none were proven.Prices are High Because They are Fixed That WayThe article in the Annals, however, proposed one conceptually simple answer.

The prices of most physicians’ services, at least most of those that involved procedures or operations for Medicare patients, were high because the US government set them that way. Although the notion that prices were high because they were fixed to be so high was simple, how the fixing was done, and how the fixing affected the rest of the health system was complex, mind numbingly complex.

Perhaps because of the complexity of its implementation, the simplicity of the concept has not seemingly reached the consciousness of most American health care professionals or policy makers, despite the publication of several scholarly articles on the subject,.efforts by humble bloggers such as yours truly, a major journalistic expose, and recent congressional hearings. The lack of discussion of this issue seemed to be a prime example of what we have called the anechoic effect, that important causes of health care dysfunction whose discussion would discomfit those who are currently personally profiting from the current system rarely produce many public echoes. (For a review of what is known to date about how the offputtingly named Resource Based Relative Value Scale Update Committee (RUC) works, and previous attempts to makes it central role in fixing what US physicians are paid public, see the Appendix.) Continue reading Another Attempt to Show the RUC Behind the Curtain

The Tremendous Value of the Teaching Value Project

teaching_values_projectBy Daniel Wolfson

Originally posted on July 29, 2013

2011 Putting the Charter into Practice grantee, Costs of Care, recently released the Teaching Value Project (www.teachingvalue.org), a series of educational video modules that spotlight ten reasons why clinicians commonly overuse medical tests and treatments. The videos are directed at residents and medical students; though I imagine some faculty could benefit from seeing them. (If the learning experience from these videos is to be maximized, faculty need to see them.)

Continue reading The Tremendous Value of the Teaching Value Project

Eagerness to Expand Health Insurance Rolls Could Pose Challenges to ACA

By Sarah Sonies

Rep. Michael Burgess (R-Texas) voiced his concerns last week that eagerness to enroll eligible low-income individuals in subsidized health insurance programs could cause challenges for the Affordable Care Act (ACA) implementation at the end of the first year.

Continue reading Eagerness to Expand Health Insurance Rolls Could Pose Challenges to ACA