The Arkansas Innovation

opinionator.blogs.nytimes.com...

The state has a vision for changing the way Arkansans pay for health care. It is moving toward ending “fee-for-service” payments, in which each procedure a patient undergoes for a single medical condition is billed separately. Instead, the costs of all the hospitalizations, office visits, tests and treatments will be rolled into one “episode-based” or “bundled” payment. “In three to five years,” John M. Selig, the head of Arkansas’s Department of Human Services, told me, “we aspire to have 90 to 95 percent of all our medical expenditures off fee-for-service.”

This is how it will work: Medicaid and private insurers will identify the doctor or hospital who is primarily responsible for the patient’s care — the “quarterback,” as Andrew Allison, the state’s Medicaid director, put it. The quarterback will be reimbursed for the total cost of an episode of care — a hip or knee replacement; treatment for an upper respiratory infection or congestive heart failure; or perinatal care (the baby’s delivery, as well as some care before and after). The quarterbacks will also be responsible for the cost and quality of the services provided to their patients, and will receive quarterly reports on those metrics from the state (for Medicaid patients) or private insurers. If they have delivered good care based on agreed-upon standards, and if their billings come in lower than the agreed-upon level, they can keep a portion of the difference. If their billings come in above an acceptable level — usually because they have ordered too many unnecessary tests, office visits or inappropriate treatments — they will have to pay money back to the state or insurer.

This seems like a great idea. While it may keep doctors from ordering unnecessary tests, it may also keep them from ordering tests just to come in "below bid". I can see much good coming from this though. Instead of several doctors, each treating different symptoms, you get one keeping track of it all. It seems lately every time you go to the doctor, you get referred to a specialist. Got an earache? Well, you need an ear, nose and throat doc. Got allergies? On to the next doctor. My wife is an RN and sees doctors from several fields treating a patient, ordering tests, ordering treatments, all without talking to each other. Now, this sounds like a great idea, till you get to the part of money back for the doctor and the government setting the standard for decent care. I really don't want a "low bid" on my health care and I really, really don't want some government panel deeming what level of care is good enough. Like I've said, good idea, but I'm just not sure they've thought this one out.

It will also enable providers to pad their portions of the bill and further rip off Medicaid and private insurers.

I doubt the 'quarterback'/ Dr. would have time to monitor all the other services for quality. It sets up conditions imho for greater fraud. Also I am against any system that uses sports analogies. Seriously?

reply to post by DAVID64


Quite simply put this will lower the level of care received. Much better to leave something alone than to fix it when you can get paid to do it the second go round rather than eat the cost on the first. A system of checks and balances should be in place to ensure no Dr. is padding the bill, this is not the solution.