Clinician Accountability And The Health Care Reimbursement Game

Our current health care system has become one big reimbursement game. Make no mistake about it - If the health care game was a little sexier, I am sure it would appear on Nintendo or Xbox and become a best seller.

As it stands, the current health care system is filled with poor and misguided incentives. The more “stuff” you do, the more procedures you perform, the more you are reimbursed. Your income isn’t based on outcome or patient satisfaction – nor is it even remotely related to it. In all reality, you don’t have to be accountable to the patient whatsoever. There is also a fine line between “fair reimbursement” and any of a number of serious words like “fraud” and “over-utilization”.

Accountability is critical – to the success of the system, and to the patient. Therein lies one of the biggest problems in the health care reimbursement game.

Clinicians are quick to point out that third party reimbursements are dropping steadily. But should you get paid simply because you spent time with the patient and billed more procedures? Should a clinician requiring a greater number of visits to attain an outcome get paid more than the clinician who requires fewer visits? Are health care services that are provided “under one roof” really for patient convenience or because they provide vastly improved and diversified revenue streams?

In the midst of these demanding issues, clinicians are perpetuating the game. Just find a better way to play the game in order to be reimbursed. As but one example, many physical therapists and chiropractors are fully prepared to add a little hot pack and ultrasound to the treatment. The rationale? It’s certainly not the science nor the evidence. So why does it happen?

“Everyone else does it, so why shouldn’t I get paid to do it as well? I am leaving money on the table.”

As long as clinicians persist with these game-playing actions, then the system will continue to exist as it is. The game will continue to evolve, but it will still be a game nonetheless.

But what do we do about it? Well, if you don’t like the system, don’t just keep gaming it – change it. Create some new business models. Dare to have the courage to offer services in a new way. Create value for the patient. Be accountable to the patient by optimizing care and outcomes, and not just having an entitlement mentality to be paid simply because you spent time with them.

The system admittedly has some faulty incentives. But trying to find the next way to game the system isn’t the solution, nor is whining about it. Years of abuse have created this problem. It’s time to move on.

Photo credits: Chase N.