Don't penalize doctors for patient behavior that can't be controlled

LETTER — Posted Feb. 20, 2006

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Regarding "Pay-for-performance at odds with the idea of patient autonomy" (Letters, Jan. 16): I agree wholeheartedly with Christine Eady, DO, of Austin, Texas, regarding the fact that performance measures should take into account those aspects of medical care over which we physicians actually have control -- i.e., education and health maintenance and treatment recommendations. Physicians don't have the ability or authority to impose our recommendations onto our patients if they are unwilling to be compliant.

I would like to offer another option to improve patient care, and simultaneously reward physicians for appropriate recommendations. Insurance companies should pay physicians our fees instead of deleting the 99214 code from their reimbursement. If they wish, they may pay us a bonus for following health maintenance and treatment guidelines, while realizing this may cause an increase in the cost of caring for patients (such as ARBs for diabetic patients, colonoscopies, mammograms, etc.). I fear that in the future we will be penalized for increasing the cost of care by adhering to these recommendations.

Additionally, the insurance companies should assign significantly higher co-pays or deductibles to patients who do not follow through with documented physician recommendations regarding performance measures. This will give the physician the positive reinforcement for adhering to recommended guidelines, and give negative reinforcement to bad behavior -- just like raising a child.

David Kerner, DO, Fishkill, N.Y.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2006/02/20/edlt0220.htm.

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