Some Cash After Metrics

The headline “Physician Compensation Programs Move Toward Value-Based Pay” suggests that this is a fait accompli, and maybe it is.  A broad survey showed “value-based incentive components in primary care compensation was up five percent from last year, with 62 percent of organizations incorporating these incentives into their physician compensation programs.”

Hmm.  “The report found that value-based incentive payments remained small at 6.2 percent of total cash compensation (TCC) across all specialties studied. That percentage only increased from 5.6 percent in 2018.”  So a small portion of total cash paid still gets a lot of ink.  Why?

One source “anticipates more physician compensation to be tied to performance metrics, such as clinical quality, patient experience, and access, as new models of care focusing on population health support the transition from volume to value.” 

Which means that more doctors’ paychecks will be tied to things over which they have no control.  Contrarily, this source predicts “physician compensation in general to increase as the healthcare industry faces a growing demand for talent amidst a looming shortage of physicians.”  Now why might that be?

The actuaries state “this demand continues to push physician compensation upwards without being supported by corresponding gains in productivity or reimbursement – resulting in higher levels of organizational investment per physician … there is a notable pressure on family medicine and internal medicine compensation without those changes in wRVU.  In order to meet population health standards, organizations must add an extra measure of performance such as panel management and telehealth to their primary care scorecards.”

So why aren’t “organizations” pushing back against Big Insurance and Big Government to reverse this stupidity?  Where is there any push back against this value-based scam?  Yes, Direct Primary Care guerillas are out in the countryside creating what havoc they can, but the AMA, AAFP, et al are still the puppet governors of the cities, slapping up “Value Based!” propaganda posters on every crumbling brick wall.  

I think organized medicine is more cynical that it is stupid, but in the end it doesn’t matter.  They know (or ought to), as does government, and you and I, that the purpose of value-based compensation, with all its nebulous, pointless, and unenforceable metrics, is NOT population health.  The entire point of this scam is to pay physicians less.  If this results in government and crony-corporatist insurance companies tightening their grip on downstream health organizations, and turning physicians even more so into government agents, then that’s just gravy. 

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Pat Conrad MD

Pat Conrad is a full-time rural ER doc on the Florida Gulf Coast. After serving as a carrier naval flight officer, he graduated from the University of Florida College of Medicine, and the Tallahassee Family Medicine residency program. His commentary has appeared in Medical Economics and at . Conrad’s work stresses individual freedom and autonomy as the crucial foundation for medical excellence, is wary of all collective solutions, and recognizes that the vast majority of poisonous snakebites are concurrent with alcohol consumption. 

  5 comments for “Some Cash After Metrics

  1. Tim
    January 13, 2020 at 9:44 am

    However, not everything that can be counted counts, and not everything that counts can be counted.

    Quote Investigator: QI suggests crediting William Bruce Cameron instead of Albert Einstein. Cameron’s 1963 text “Informal Sociology: A Casual Introduction to Sociological Thinking” contained the passage.

  2. Kurt
    January 12, 2020 at 11:38 am

    Pay the freaking patients if they hit performance parameters not me. They go out the door with 150 pages of computer generated self help info and continue lousy behaviors. Diabetics who need to go on insulin but refuse, hypercholesterolemics who continue to eat s#!T and of course the obesity situation that is ravaging the country at the moment. Anyone who encourages students to go into FP should roast in Hades. I’m sorry but DPC won’t work everywhere. The people have to have the disposable income to pay the monthly rate. Too many sucking on the government teat and you’ll go bankrupt.
    I’m glad retirement is 22 months away.

  3. Steve O'
    January 12, 2020 at 9:34 am

    This is just one manifestation of The Big Trap that all of American Business is in, without knowing it. If one wishes to construct a performance-measuring algorithm, it becomes more complex, the more sophisticated the thing is you are measuring. But Corporate Suite Suits in Healthcare don’t have the slightest idea what constitutes GOOD HEALTHCARE. So they choose instead the easiest thing to measure. We could base pay-for-performance on “number of patients struck by lightning.” That’s easy to measure. But measures that cannot be controlled by the participants just lead the participants into the slough of despond. “Ah – let’s outlaw umbrellas! And Golf! That will cut down on the lightning-related deaths!” Indeedy.
    All of America measures complex performance by witless rules, constructed by people ignorant of the process they are measuring, but confident that if you measure it, you can manage it. Like we do with Global Warming, no?
    If you measure healthcare to death, you beach it upon the shore of Triviality. It becomes trivial to perform, so what’s with this requirement to have trained robots check off the checkboxes? Let’s go with untrained robots. And so, the cost goes up and the quality goes down, and the US approaches third-world medicine.
    By the way, the reason that the stock market is “booming” is that there is a lot of cash available in nearly-free loans, and that cash allows the big corporations to borrow money to buy back their own stock. If a corporation buys back 50% of its stock, the price doubles. Easy math. But it did so by decreasing its net value. You remember, you heard it here before The Great Plunge.
    Now, corporations are crying about the increased cost of decreased availability of physicians. Stock markets are supposed to be the complex machinery for determining value-based performance, and they sure as hell haven’t been doing that for ten years.

    • Pat
      January 12, 2020 at 12:22 pm

      “…beach it upon the shore of Triviality.” Nice!

  4. Perry
    January 12, 2020 at 8:13 am

    Exactly. They are not pay schemes, they are anti-pay schemes.

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