Each fee is meant to reimburse the doctor for the time and skill he or she devotes to the patient. But it is also supposed to pay for overhead, and this is where the problem begins. To Medicare, a doctor’s overhead (or “practice expense”) includes such items as rent, staff salaries and the cost of high-tech medical equipment. When the agency pays a fee to a doctor who has performed a CT scan, it is meant to cover some of the cost of buying or leasing the scanner itself. Services using more expensive equipment generate higher fees....
In contrast, the doctor-patient visit, which involves no expensive equipment, offers no significant profit opportunity. So the best way for a doctor to make money in his practice is not to spend time with patients but to use equipment as much as possible. That means moving the maximum number of patients through the practice, and spending the minimum amount of time with each one.
I can certainly understand the abuse of such a system from the standpoint of ordering unnecessary tests for the sake of paying off an expensive piece of equipment to generate more profit. I certainly recognize the immorality of such practice. But on the grand scheme of things, I have to disagree with the argument that more face-to-face time spent with patients automatically equates to better quality of health care. Advancements in medical imaging technology are giving doctors more targeted and informative information about a patient's condition. These tests can also allow doctors to provide care to a growing number of patients because they do not directly require the doctor's presence.
Although it can be argued that some of these tests, such as CT scans, may sometimes be ordered unnecessarily, it is hard to extend a blanket statement criticizing the utilization of diagnostic imaging and tests over direct patient contact. Such arguments imply that the increased use of such tests equates to reductions in quality of care (as implied by the title of the article: paying doctors to ignore patients). Certainly, face-to-face interaction is an important aspect of establishing a healthy relationship with one's doctor, but it isn't the be all end all when it comes to improving patient prognosis.
I guess the line is blurred between two perspectives. From the optimist's perspective, the use of tests allow doctors to provide better health care to more patients. But there's always the more negative perspective, in which doctors simply view patients as resources, ordering test after test to reap the profits. As discussed in the article, doctors that directly own CT scanners order scans
more frequently than doctors who have access to institutional scanners:
Doctors who do their own CT scanning and other imaging order roughly two to eight times as many imaging tests as those who do not have their own equipment, a 2002 study by researchers at the University of North Carolina found.I guess a little bit of both views ring true today...
Although my understanding of the health care system is certainly incomplete, I would agree (at this point) with the proposed elimination of fee-for-service payment plans. In my eyes, this would help resolve the latter situation (extraneous ordering of tests to pay overhead).
