What's the Latest Development?
New York City's public hospitals are currently in negotiations with the doctor's union to make a certain portion of doctors' salaries conditional on measurements like patient outcomes and cost containment. The move represents a national push away from the traditional model of rewarding doctors for the volume of services they offer. Among the 13 performance indicators proposed by the hospitals are "how well patients say their doctors communicate with them, how many patients with heart failure and pneumonia are readmitted within 30 days, how quickly emergency room patients go from triage to beds, whether doctors get to the operating room on time and how quickly patients are discharged."
What's the Big Idea?
The doctor's union has proposed 20 performance indicators, adding ones such as going to community meetings, giving lectures, getting training during work hours, screening patients for obesity and counseling them to stop smoking. Dr. David U. Himmelstein, professor of public health at the City University of New York, has studied incentive pay literature and warns that gaming the system is not difficult. "He said that when primary-care doctors in England were offered bonuses based on quality measures, they met virtually all of them in the first year, suggesting either that quality improved or—the more likely explanation, in his view—'they learned very quickly to teach to the test.'"
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