Global payment = global pain in the butt?

Looks like fee for service didn't control costs in Massachusetts so they want to switch to paying docs per patient. If the doctor keeps the patient healthy he makes some money. Polticians must imagine that physicians have some kind of voodoo magic to make patients lose weight and quit smoking. Will they be able to fire a noncompliant patient? Will they be able to say that difficult cases are beyond the scope of their practice? Will they be able to turn down a patient's 732,930th request for an appointment for pain killers, loneliness, or that disturbing ache in the pinky finger?

This brings to mind the schemes that are put in place in prisons to keep food budgets under control. If a warden keeps the budget down he's allowed to personally pocket some money.

In Alabama earlier this year, a federal judge ordered the Morgan County sheriff locked up in his own jail for contempt for failing to adequately feed his inmates. Alabama allows sheriffs to keep food money they do not spend, and the sheriff reportedly pocketed more than $200,000 over three years.

Well, I'm not going to be one of those people that a doc can keep healthy. I'm not sick because I'm fat, I don't have hypertension or diabetes or any other "lifestyle" disease, I have Crohn's and I'm going to be a big pain in the butt to treat for any doctor who is rewarded for healthy patients. Perhaps one of the ways that a GI will be able to save a little money from me is to not use conscious sedation during a colonoscopy , an oft repeated event in the life of a Crohn's patient.

Colonoscopy without sedation is common in Europe and Asia, and efficacy is
comparable."There have been several studies that show that if you have motivated patients, a significant fraction of them can have a colonoscopy without sedation," said Douglas Rex, MD, past president of the American College of Gastroenterology

That's right, folks, lack of sedation is one way to keep costs down. We might quite literally take this one up the ass if it becomes national policy.

Enjoy those govt provided "free" well baby check ups.