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Friday, October 14, 2016

Medicare unveils far-reaching overhaul of doctors' pay

Keep it Simple or Keep it Complex? The portrayal of the seeming many fronts of healthcare to be managed is illustrative of the complexity of our current system. While many tout the evils of a fee-for-service healthcare model, the reality is that our current system is not a true fee-for-service model. In the current model, there is not price transparency and consumers, providers and insurers are shielded from market forces. The headwaters for how healthcare is provided stems from it's financial structure/incentives. Everything downstream of this is a consequence--good and bad--of that financial structure. Applying patches (like MACRA) downstream adds complexity to the healthcare system without effectively addressing the source for a dysfunctional system. True fee-for-service and price transparency is a way to bring market forces to bear upon patient choice, quality, cost and innovation in medicine. A true fee-for-service may offer the simplest way to achieve outcome goals of quality, price and accountability. What we suffer from currently is not true fee-for-service but rather a fragmented system where the financial structure is not aligned with value or accountability. So, we have introduced (and continue to introduce) "patches" to fix the non-alignment. The patches add complexity without evidence of effectiveness. Instead of following the KISS method we have chosen the "keep it complex" method. There is no healthcare reform without healthcare finance reform.
from Rajesh Harrykissoon, MD