Health Care Quality Measures Are Not Part of Physician Incentives

The Wall Street Journal health blog reported that a large physician search firm said that seventy-four percent (74%) of the jobs  recruited for in the year ending March 31 featured a performance bonus for physicians, and ninety percent (90%) of the time the bonus  was linked to volume, not quality.   This is often called “fee-for-service.”   Less  than seven percent (7%) bonuses tied physician rewards to  quality or cost goals.

Fifty-six percent (56%) of physicians nationally are employed by hospitals, an increase from fifty-one percent (51%) in the prior year and only twenty three percent (23%) in 2003 to 2005.   This trend is accelerating because hospitals are buying physician practices and merging other hospitals.

Clearly health care payment reform will not work unless the fee for service model is changed to a model with shared risk for physicians and a focus on quality.

Michael F. Arrigo

Michael is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. He leads a team that provides Cybersecurity best practices for healthcare clients, ICD-10 Consulting, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, Insurance Fraud, payor-provider disputes, and consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been quoted in the Wall Street Journal, New York Times, and National Public Radio.

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