How insurance companies see us
A good friend loaned me a book called The Information Cure. It is written by Jeff Margolis, who is the CEO of the TriZetto group, which provides “enterprise information solutions to U.S. healthcare payers.” (I’m not sure what this means.) However, there is was an enlightening section on how insurance companies view physicians and health care providers when a patient status post hip replacement gets what appears to be MRSA.
Mr. Margolis faults the hospital for the infection. “If the hospital had known in advance that it would be paid only for the original planned hospital stay and hip replacement procedure, would that have made the hospital more likely to follow evidence-based medicine protocols? What if we paid doctors and hospitals for the procedures they were supposed to perform in the first place and not for the care that resulted from medical?”
The view is that infections, errors and bad outcomes occur because physicians and hospitals get paid more if there are complications. He makes the case that we don’t pay attention to details such as clean hands because we don’t get dinged monetarily for infections, rather we are “rewarded” by making money off of complications. Margolis claims that if we were paid for performance we would rapidly eliminate errors, infections and bad outcomes. He completely disregards the fact that things go wrong, in spite of our best efforts. He implies we are only motivated by money, not that we personally care about the health of our patients.
It is sad how easily we distrust each other. The insurance industry so easily points fingers at physicians, claiming that rising health care costs are the responsibility of the germy, unclean physicians that care not a whit except for the money earned, and that physicians greedily anticipate making more money from the complications they so easily induce.
Don’t get me wrong–many errors and bad outcomes can be avoided with proper procedures. But to think that physicians care not about bad outcomes is ridiculous. Yes, we care about the bottom line, but more importantly, we really do care about our patients.
Tags: heatlhcare reform, physicians responsibility, The Information Cure
We all dislike insurance firms, only where would we be without them.