Issue link: https://tmcpulse.uberflip.com/i/900421
t m c » p u l s e | o c t o b e r 2 0 1 7 35 If physicians were against the concept, it just wouldn't fly. But I think the data are clear that even without consciously changing their practice, they will order fewer tests and do fewer procedures. — ARTHUR "TIM" GARSON JR., M.D., MPH Director of the Texas Medical Center Health Policy Institute fee-for-service to "pay-for- performance," in which a portion of doctors' pay is tied to patient out- comes. But according to Garson, that transition has been slow, it's enor- mously complex and physician pay is still based on volume. His solution: Start paying doctors salaries. Doing so would remove incentives— even unconscious ones—to pursue costlier treatments, and it would drasti- cally reduce the amount of paperwork doctors must complete, Garson argued. He cited research studies showing a 9 to 33 percent reduction in lab tests and procedures associated with physi- cians who were paid salaries. A new national survey by the TMC Health Policy Institute indicates that U.S. doctors might actually opt for salaries over the existing form of pay. The survey found that 69 percent of doctors said their preferred method of compensation would be a high propor- tion of their pay as straight salary with a low proportion of their pay based on incentives, or a straight salary with no incentives at all. "I am encouraged," Garson said. "If physicians were against the concept, it just wouldn't fly. But I think the data are clear that even without consciously changing their practice, they will order fewer tests and do fewer procedures." A vast majority of studies have concluded that with less overtreatment, patients may actually do better, he added. To encourage the transition to doctor salaries on a wider scale, Garson said, CMS could pay a bonus to physician groups that choose to compensate the majority of their physicians primarily via salaries. Commercial insurers could implement a similar strategy. Perhaps it's telling that some of the country's top health care providers rec- ognize the merits of the salary system. The Mayo Clinic, the Cleveland Clinic and the Kaiser group in California all pay physicians salaries without volume incentives. Officials at the Mayo Clinic say they've deliberately chosen to sal- ary their physicians in order to reduce the potential for conflicts of interest. "The vast majority of physicians care first and foremost about their patients," wrote UCLA's Ian Larkin and Carnegie Mellon University's George Loewenstein in a widely-read column in the Journal of the American Medical Association published earlier this year. "But a significant body of literature in the social sciences demonstrates that financial incentives can and do influ- ence decisions in ways not recognized by decision makers." "The Nation's Pulse: The Texas Medical Center's Consumer & Physician Survey," is available at tmc.edu/health-policy/ E AC H O N E O F U S I S U N I Q U E with our own life story to tell. We understand this, and that's why you can depend on your Dignity Memorial ® professionals to capture a person's essence with a service that's both a fitting reflection and a memorable tribute. > DignityHouston.com < MEMORIAL OAKS Funeral Home & Cemetery HOUSTON 281-497-2210 FUNERAL HOME AND CEMETERY LOCATIONS THROUGHOUT THE GREATER HOUSTON AREA, INCLUDING: EARTHMAN Funeral Directors – Hunters Creek HOUSTON 713-465-8900 www.prepaidfunerals.texas.gov No two of us are alike. a memorial service should reflect that.