Comments on: DrLyle’s Thoughts on the President’s AMA Speech 6/15/09

By: George Margelis

George Margelis — Thu, 18 Jun 2009 13:02:09 +0000

Great piece Lyle
I wish some of our local (Australian) politicians could speak with the same fervour around the need for healthcare reform.
Maybe I need you to come back and restoke the fires.
Seriously it is refreshing to see this level of leadership being taken on the important issue of healthcare reform. I wish you luck with it and hope my government is watching with great interest.

By: Gregg Alexander

Gregg Alexander — Wed, 17 Jun 2009 14:23:35 +0000

Dr. Lyle, I may not wait for a national lottery! May be a good idea for just our local little practice to encourage regular check-ups! (I see many folks who can’t afford or remember other stuff which needs attention standing in line weekly to buy lottery tix at 20 bucks a pop!)

I, of course, understand that the non-compliant will suffer from their own neglect, but I worry we may create a financial disincentivization to continue to see those difficult patients.

By: DrLyle

DrLyle — Tue, 16 Jun 2009 18:01:25 +0000

My best comment is that there is no single answer, but if we create the RIGHT INCENTIVES – then let the market and providers be creative and innovative in figuring out how to deal most efficiently with both the doctors/patients who want to work together, as well as those who don’t. America has always been built on that concept – and it can be a double edged sword since the reimbursement system has to be well balanced for quality and cost, but I think we are much closer in a setting where we get “care coordination” PMPM fees vs. simple FFS fees.

I’d add that I do agree with the idea of “rewarding” patients who are compliant (eg provide a partial refund on insurance premium or give bonuses to buy healthy things/services)- assuming that the definition on compliance is very clear and obvious. Of course, that may just be a nice way of saying we are punishing those who are not compliant. But let’s also recognize regardless of financial rewards/punishments, the non-compliant will suffer in their own way (eg poor health). And they should not drag down their doctors with them financially, as there have always been things like stop-losses and other measures to ensure that won’t happen. But again, with the right incentives in place – it will be very interesting to see what people come up with – I still remember hearing about the pre-natal clinic which gave away lottery tickets to get all the economically disadvantaged mothers to come into the clinic – it worked well and created an enormous ROI by decreasing pre-term births. Hmmm… maybe that is the answer for the rest of America – see your doctor, be compliant, and get a national lottery ticket!

By: Gregg Alexander

Gregg Alexander — Tue, 16 Jun 2009 12:22:09 +0000

Outcomes-based payments make sense from a preventative care perspective, absolutely. It has long been an exquisitely unbalanced reimbursement system that pays so well for procedures and so poorly for the oft more complicated, demanding, and time-consuming patient education, guidance, and preventative care delivered by primary care providers.

However, I’m curious:
1) Won’t poor compliance on a patient’s part require unbalanced effort and services on the physician’s part in an attempt to bring them along, creating unfair demands upon the provider’s time for the uncooperative, eroding their availability for the cooperative?
2) Will providers be incentivized to retain non-compliant patients who would otherwise erode their income base?
3) Just as there will be financial “punishments” for providers if patients are non-compliant, will uncooperative patient also have financial reprimands for their unhealthy behaviors?