Recently, another predictable Trojan-horse provision of the Patient Protection and Affordable Care Act appeared that promises to pit doctor versus patient by literally placing a price on patients’ heads:
Twenty-thousand physicians in four Midwest states received a glimpse into their financial future last month. Landing in their e-mail inboxes were links to reports from Medicare showing the amount their patients cost on average as well as the quality of the care they provided. The reports also showed how Medicare spending on each doctor’s patients compared with their peers in Kansas, Iowa, Missouri and Nebraska.
The “resource use” reports, which Medicare plans to eventually provide to doctors nationwide, are one of the most visible phases of the government’s effort to figure out how to enact a complex, delicate and little-noticed provision of the 2010 health-care law: paying more to doctors who provide quality care at lower cost to Medicare, and reducing payments to physicians who run up Medicare’s costs without better results.
Of course, no real assessment of physician "quality" is taking place with this scheme nor any outcome assessment. "Quality" as it is defined in this scheme consists of only an electronic review of patient costs, doctor billing codes, and thepatient characteristics of age, gender, Medicaid eligibility, and medical conditions. No government entity will actually observe and assess any physician in practice to determine their "value" to the system. Instead, patients electronically determined to be "low-cost" will be heralded as favored electronic "value" benchmarks. Even the health care law’s original physician cheerleader, former Administrator of the Center for Medicare and Medicaid Services Donald Berwick, MD, was taken back:
“We do have to be cautious in this case. It could lead to levels of gaming and misunderstanding and incorrect signals to physicians that might not be best for everyone.”