Thursday, May 22, 2008

Managed care - How Doctors React to Being "Managed"

Last week I blogged on how a former corporate medical affairs executive thought independent practicing doctors should be managed.

Among other things, he said corporations should,

• regard health care as just another product,

• deal only with doctors who comply with product specifications,

• judge doctors to whom to refer by judging value (cost/quality).

• pay only for evidence-based care.

Doctor readers reacted swiftly. My blog rating dropped sharply by 40%. Negative comments ensued. Being a messenger of bad news bore adverse consequences.

I’m not surprised how doctors reacted. Twenty years ago, I wrote in And Who Shall Care for the Sick? The Corporate Transformation of Medicine in Minnesota (Media Medicus) that managed care was doomed to fail. And in a second book, Managed Care Memor: A Physician’s Whistle-Stop Journey, 1983-2003 (Infinity Press, 2003), I elaborated on why managed care was failing. In essence, I said doctors think of themselves as professionals to be trusted, not as providers to be managed, or as cost-generating renegades to be reined in.

For years, I’ve argued with this medical executive that,

• You can’t manage care like other, more tangible products because medical practice is a subjective, complex interactive human activity;

• You can’t force doctors everywhere to comply with product specifications because care varies with local cultures;

• You can’t base payment solely on “evidence-based” care because more thant 50% of doctor visits aren’t evidence-based; visits are human-based, neighborhood-based, relationship-based, and circumstance based. .

• Ultimately, you can’t judge physicians on outcomes depend on how patients behave once they leave the doctor’s office, not on what the doctor does at the point of care.

• If you want to control costs, deal directly with physicians rather than through their human relations departments or through managed care surrogates, and make your case with irrefutable data.

Case closed.

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