Physician Payment Methods
There are several approaches to paying physicians, including direct payment for services rendered. Typically, this method is calculated based on the usual and customary fees physicians charge in a given geographic area (Heath, 2020). A similar distribution applies to the discounted fee-for-service approach, which, in addition to payment for each service or analysis, includes either a payment schedule or a predetermined discount from a fixed rate (Miller-Breslow & Raizman, 2020). These methods focus on the number of services provided without reference to the number of patients served.
Capitation is a different perspective on physician compensation. In this regard, the number of services is not measured; rather, the number of participants in the treatment process with whom the doctor directly interacted is measured. However, given the difficulty of assessing the quality and quantity of resources spent due to the specifics of the activity itself, which often involve many additional services, this approach requires appropriate correction (Erickson et al., 2020). It consists of allowances that reimburse the costs of additional assessments while enhancing patient safety monitoring. This alternative is divided into patient-centered medical homes and direct primary care, which partly combine the features of capitation and fee-for-service approaches (Erickson et al., 2020).
Finally, they also include the salary approach, which is not tied to the number of patients or services provided – this method is considered to demotivate doctors (Brekke et al., 2020). More flexible, yet comprehensive, remuneration has greater potential to positively impact psychological and economic aspects than the one-fits-all approach.
Payment Change Implementation
One of the policies proposed by the American College of Physicians calls for these steps in implementing payment changes. She posits that reviewing the healthcare delivery and payment system is essential to improve efficiency (Erickson et al., 2020). The transition to hybrid payment models, considering the load in terms of the number of patients and the services provided, is obvious. In addition, such approaches improve physician motivation and are more accessible to low-income patients (Erickson et al., 2020). Given this industry’s high social responsibility, greater accessibility while maintaining professional satisfaction is an ideal goal.
The sixth recommendation on the list continues the trend of pay equity through different compensation approaches. It underscores the importance of primary care and other medical fields, underscoring the need for appropriate compensation for physicians in these fields (Erickson et al., 2020). Primary care lays the foundation for further patient treatment; this problem must be addressed at a higher organizational or even federal level. Low-income patients cannot access this type of assistance if the need to increase prices is passed on to service users. Such a consequence is fundamentally contrary to medicine’s original and fundamental goal: patient safety.
However, even if it were possible to increase payments to doctors and related specialists, the balance between motivation and fairness would still need to be carefully calibrated using a value-based approach. A similar issue is addressed in the college’s tenth recommendation, which calls for a more flexible approach to assessment and performance requirements (Erickson et al., 2020). Here, the basis of the patient-centered method is evident, manifesting in the mechanisms for generating requirements and their public reporting. Such a move is essential and could result from the flexible wage model, which will increase transparency and control in the industry. However, the policy here requires ongoing updating of requirements and their specificity; resources devoted to this activity can also help achieve recommendations, for example, 9 and 12.
The issue of fair pay is truly a pressing issue in medicine. However, current developments in various areas, including patient-centered medical homes and direct primary care approaches that combine both the number of patients and services provided, are areas that medical facility management and decision-makers should rely on. The American College’s demands largely center around the trade-off between maintaining affordability for the end consumer and increasing physician pay: the high level of attention to the issue underscores its urgency.
References
Brekke, K. R., Holmås, T. H., Monstad, K., & Straume, O. R. (2020). How does the type of remuneration affect physician behavior? Fixed salary versus fee-for-service. American Journal of Health Economics, 6(1), 104-138.
Erickson, S. M., Outland, B., Joy, S., Rockwern, B., Serchen, J., Mire, R. D. & Medical Practice and Quality Committee of the American College of Physicians. (2020). Envisioning a better US health care system for all: health care delivery and payment system reforms. Annals Of Internal Medicine, 172(2_Supplement), S33-S49.
Heath, J. (2020). Ethical issues in physician billing under fee-for-service plans. In The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine (Vol. 45, No. 1, pp. 86-104). US: Oxford University Press.
Miller-Breslow, A. J., & Raizman, N. M. (2020). Physician reimbursement: fee-for-service, accountable care, and the future of bundled payments. Hand Clinics, 36(2), 189-195.