Cutting health costs by paying doctors more?
Dr. Richard Baron, right, is paid extra to spend more time with patients like Robert Williamson.
Multimedia
That is the premise of experiments under way by federal and state government agencies and many insurers around the country. The idea is that by paying family physicians, internists and pediatricians to devote more time and attention to their patients, insurers and patients can save thousands of dollars downstream on unnecessary tests, visits to expensive specialists and avoidable trips to the hospital.
Nationally, Medicare and commercial insurers pay an average of only about $60 a visit to the office of a primary-care doctor and rarely if ever pay for telephone or e-mail consultations. Many health policy experts say the payments are not enough to let the doctors spend more than a few minutes with each patient.
Robert Williamson, a 60-year-old Philadelphia man, recalls the cursory exam he received a few years ago from a harried doctor who, Mr. Williamson says, missed the danger signals and sent him home. A short time later Mr. Williamson had a stroke.
For want of a careful examination by a primary-care doctor, Mr. Williamson became one of countless Americans each year whose unidentified or under-treated illnesses escalate into medical conditions with catastrophic personal and economic costs. Besides incurring $30,000 in hospital bills paid by his employer’s insurer, Mr. Williamson had to stop working as a customer service representative at Philadelphia Gas Works and go on Social Security disability, at a current cost to taxpayers of $1,900 a month.
With Mr. Williamson’s new doctor, such an outcome would be much less likely.
“I give him my heart and diabetes readings by e-mail and phone, without getting up out of my chair,” Mr. Williamson said. “I can get better directions, at the very moment I need them. It’s life-saving.”
His current internist, Richard Baron, is one of more than 100 physicians in metropolitan Philadelphia taking part in the experiment, which is being conducted jointly by some of the region’s largest insurers. Dr. Baron still gets a fee of only about $64 for each office visit. But his five-doctor group will also receive $200,000 to $300,000 this year beyond their regular fees to keep better track of their 8,400 patients.
“We are trying to do more e-mail care and telephone care, which we haven’t been paid for in the past,” Dr. Baron said.
Insurers are conducting similar pilot projects in at least a half-dozen states, in experiments involving thousands of doctors and nearly 2 million patients. Many more are in the planning stages, at the urging of health policy experts and employers that provide medical benefits.
The big government health care programs, Medicaid and Medicare, are also studying the concept. A Medicaid experiment already under way in North Carolina saved the government program in that state about $162 million in 2006. That was 11 percent less than the state would have spent under the old system of reimbursement, according to an audit by Mercer, a consulting firm.
Earlier this month, as part of a bill to protect Medicare payments to doctors, the Senate overrode President Bush’s veto to authorize $100 million to finance a three-year Medicare pilot to further test the concept of spending more on primary care.
Under the various payment experiments, family doctors are encouraged to hire additional staff to help monitor patients’ treatment and follow-up, and to help patients stay ahead of problems by sending reminders when they are due for preventive tests like mammograms and colon exams.
For people like Mr. Williamson with serious chronic illnesses, the doctors take personal charge, answering patients’ phone or e-mail questions promptly. In emergencies, patients can show up at the office and see their doctors on short notice.
Such features add up to a model of primary care that proponents refer to as providing people with a “medical home” — a base where doctors, staff and patients pull together as one big health-care family. Or at least that is the ideal.
“It’s the latest new, new thing — testing whether medical homes can be a vehicle for pulling America upwards from the grossly inefficient swamp in which our health system is currently mired,” said Dr. Arnold Milstein, a senior consultant at Mercer who is also member of the Medicare Payment Advisory Commission, an independent Congressional agency.
Trying to Save by Increasing Doctors’ Fees
(Page 2 of 2)
The panel has recommended that Medicare expand its plans for a medical-home pilot project next year that is expected to pay primary-care doctors in eight states $30 to $40 a month extra for each person enrolled with a chronic illness.
