April 2, 2014

Less Pay  For More Health Care Work

Less is more.

Popular aphorism, attributed to architect Ludwig Mies van der Rohe (1886-1989)

About three-quarters will find their premiums are higher than they had previously with other insurance…We’re going to get paid less for what we do. We’re going to be paid less for what we do.  Hospitals are going to be paid less for what they do. We also know insurers are paying less for what we do.

Tony Cosgrove, MD, “Cleveland Clinic CEO: Three-qurters of Americans Who Signed up for Obamacare Now Have Higher Premiums, “  CBS News,  March 31, 2014

What will happen when hospitals and doctors are paid less for what they do?      

The Obama administration is betting  hospitals and doctors will become more efficient, and will change their business models  to Accountable Care Organizations,  Medical Homes,  Team-Based Care and  will give up fee-for-service for bundled care, to provide more care for less cost.

“Less for more” may have a nice ring to it for architects, home decorators pushing for a starker, simpler look; and for the sophisticated cash-short searching for answers.

It may not work that well in health care.  

It is more likely:

·         marginal hospitals will close, 

·         more doctors will go to work for hospitals seeking economic security, 

·         more government-sponsored clinics will open,

·         more scheduling doctor visits will take longer,

·         waiting lines in doctors’ offices and at ERs will grow longer,

·         fewer doctors will accept Medicare and Medicaid patients because of lower fees,

·         more doctors will quite traditional practices to enter cash-only concierge or retainer practices. 

That, more or less, is what is likely to happen,  once being paid less to do more when more government insured and subsidized patients crowd into already over-burdened d doctors’ offices and overcrowded emergency departments.

“Less is more,” less pay for work by health care professionals,  sounds to good to be true.   And predictably,  patients, hospitals, and doctors will not greet “less is more” with enthusiasm.   

 Government may say more efficiency is the answer to the nation’s health care cost woes,  but the converse is more likely.  It simply doesn’t ring true, considering the government’s well earned reputation for wasteful spending and inefficiency. 

As Peter F. Drucker (1909-2006), father of modern management, observed:

 The best we get from government in the welfare states is competent mediocrity.  What is impressive is the administrative incompetence.  Every country reports the same confusion, the same lack of performance, the same proliferation of agencies, of programs, of forms, and the same triumph of accounting rules over results.”

Tweet:   Under ObamaCare, premiums for ¾ of us are likely to rise, and hospitals and doctors will paid less to do more, with predictable results.

________________________