Dear Patient, In Medicare’s Effort To Improve Quality, The Doctor Won’t See You Now

Dear Patient, In Medicare’s Effort To Improve Quality, The Doctor Won’t See You Now

By Mary Johnson

The Centers For Medicare and Medicaid Services (CMS) recently announced a bold new model to save money and improve healthcare quality by changing the way the government pays doctors. The Administration is taking steps to ensure that, by 2018, up to half of all payments to doctors won’t be for visits and procedures, but rather for providing “high quality” care. The plan is to pay doctors on how they perform.

Currently doctors are paid for every service they provide, giving a big incentive for wasteful duplication. Patients wind up getting repeated tests, X-rays, CT scans and procedures involving expensive computerized equipment.

What does this new “pay for performance” mean for patients? Not much is known yet, but I got a first - hand experience of the new system recently. One of my doctors, a specialist, told me that due to a “quality initiative reorganization,” he wouldn’t be seeing me as a patient anymore. I’ll have to find a new doctor.

Even though I’m not on Medicare yet, these new quality initiatives will, one way or another will affect most patients, even those like me who are still under the age of 65 as doctors reorganize. I felt dumped.

I spent the better part of last year trying to determine the cause of, and best treatment for, a mysterious chronic cough. A non-smoker, I’m usually obnoxiously healthy. Last year, though, I went through a battery of four specialists, a long menu of tests, underwent surgery and spent a night in the hospital. Yet by January of this year the cough was worse than ever.

In January as my specialist told me goodbye, he gave me a 10-day prescription for a simple $8.16 antibiotic. Did I get better? Yes, at least for now. While the antibiotic treatment was inexpensive and seems effective at curing the cough, the CT scan and bronchoscopy he ordered last year cost about $4,000 before insurance. Would I have done just as well getting that prescription from my primary care doctor and skipping all the rest? Maybe, but how does the patient make that judgment?

Specialists are already warning that under the new “quality initiatives” some patients may have difficulty finding services under the new system as doctors join larger practices or stop accepting patients. As doctors reorganize and move into new HMO - like Accountable Care Organizations, all sorts of new questions are coming up. Does this payment system create an incentive to send unprofitably sick patients with complicated conditions elsewhere for care? How will the government measure quality, and what evidence will the Administration use to determine successful doctor performance?

The fact is there isn’t much information yet— even though doctors and their staff are reporting huge amounts of data mandated by the 2010 health law. Based on what I’ve been able to learn, the Administration is still tinkering with the system.

Have you had a similar experience? Share your experience with TSCL.