October 6, 2012
President Barak Obama
1600 Pennsylvania Ave. NW
Washington, D.C. 20500
Dear Mr. President,
In the debate you had Wednesday night with Governor Romney, you mentioned that doctors should be paid based on “pay-for-performance”, a concept where doctors get paid based on their patient outcomes, rather than the number of procedures they perform. Thus, as a family doctor, if my patient does not follow my advice, and has a less than ideal outcome, I will get paid less than if the patient has a good outcome. Well, I have a great problem with that.
Doctors work hard to get their patients to maintain healthy lifestyles and take good care of themselves, but even the best doctor in the world will not be successful in getting every patient to comply with his or her advice. Let’s say a patient smokes, and despite urging from his doctor, the patient continues to smoke, and has complications from it. Under this scenario, the doctor would be paid less since the patient had an adverse outcome. This would apply to diabetes, obesity, etc. This hardly seems fair or realistic and potentially may lead doctors to avoid caring for non-compliant patients, or, even worse, leaving the medical field. How is the government going to convince young people to become doctors and become primary care specialists such as myself, if you don’t make it appealing to them? We are in desperate need for more primary care docs, not less.
I believe that if this is going to be your policy towards the medical profession, then you should include yourself and Congress in this reimbursement model. If a congressman’s law he introduced does not pass, then a percentage of his income is lost. Unemployment does not go down, and you, as the leader of our nation, gets paid less, or loses some other perk. Please do not be a hypocrite and exclude yourself and other elected officials from this concept. Show some leadership! It is the only right thing to do if you expect others to accept this system of payment. I trust you will do the right thing for yourself, and likewise encourage the Congress to do the same.
Stephen Behnke, M.D.