Talk is Cheap: U.S Pays for Performance of Procedures

Our analysis indicates that Medicare reimburses physicians 3 to 5 times more for common procedural care than for cognitive care and illustrates the financial pressures that may contribute to the US health  care system’s emphasis on procedural care. We demonstrate the 2 common specialty procedures (a screening colonoscopy and extracting cataracts) can generate more revenue in 1 to 2 hurs of total time than a primary care physician receives for an entrie day’s work.

Abstract – “Medicare Payment for Cognitive vs Procedure Care,” JAMA Internal Medicine, August 12, 2013

It’s ironic.  With all the health reform talk about Pay for Performance, or P4P, as it’s known to policy making insiders, the US still pays far more for performing procedures – not for performance of physicians evaluating and talking to patients, emphasizing prevention, and developing conservative treatment plans.

This state of health affairs may be lamentable.  It may be less than ideal.  It may be resolved by ending fee-for-service, bundling bills to pay for episodes of care, putting physicians on salaries, or somehow erasing income differences between specialists and generalists.

But it is a cultural reality.

As I noted in a March 6, 2011 Medinnovation blog.

"But there’s a huge cultural problem.   We’re an action-oriented people. Talk is cheap.  Americans want deeds – a prescription,  a laboratory test, a CT or MRI,  a procedure.  Anything.  But something concrete.  Something you can touch, feel, take, ingest,  inject,  point to, grasp, identify,  undergo.  Something  you can share with friends and family,  even if it’s a surgical scar, a pacemaker,  a hip or knee prosthesis.   American can get all the talk they want – from talking heads on radio and TV,  from channel news shows, from the Internet, and from bloggers like me."

Tweet:  The American health system rewards doctors 3-5 times more for performing procedures than talking to and advising patients.