How We Pay Our Doctors Might Be Killing Us

Question: How should healthcare be overhauled?


Nicholas LaRusso: Our new president [Barack Obama] has identified as one of his three major areas of attention, health care which by the way I personally applaud and Mayo has worked through its health policy institute to articulate the four pillars that are necessary for transforming healthcare. Those 4 pillars then provide the environment with which the Center for Innovation, and innovation across the country in health care delivery can evolve.


Those pillars are pretty simple. Conceptually, they include creating value, coordinating care, restructuring the payment system, and providing universal access. Those are the four pillars.


For the innovations that we envision helping to catalyze through our Center activities, to be maximally effective, there needs to be policy changes that address those four areas. Care coordination, value, payment reform and universal access.


Topic: An example of healthcare reform.


Nicholas LaRusso: If you’re in charge of a delivery system, and you’re being reimbursed because of the quality or value of the care that you provide, and because of the coordination that you provide, rather than on the number of tests that are done, then that provides a whole different set of incentives for you to reorganize the way you deliver health care.


This gets back to one of the four pillars of our policy initiative, and that is payment reform. Right now the payment system results in just what you expected it to do. That is, if people get paid because they do a lot of stuff, they’re going to keep doing more and more stuff to get more and more pay. But if you pay people for the quality of what they deliver, and you define quality or value, and you have metrics for value, and you make those metrics publicly available so the consumer knows where to go to get the highest value care, and you coordinate things.


Recorded on: June 24, 2009.

Mayo Professor and Director, Dr. Nicholas LaRusso, says we need universal access, coordinated care, value and payment reform.

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