Senator Michael Bennet met with the Denver Chamber of Commerce members this week to discuss health care reform and answer questions. The Chamber of Commerce tends to prefer market-driven solutions, and is opposed to any sort of public option health insurance plan, feeling that it would operate with an unfair advantage over private health insurance. The Chamber is also opposed to mandates requiring that employers provide health insurance workers, but is in favor of mandates requiring individuals to carry health insurance. Sen. Bennet’s views on health care reform are detailed on his website, and tend to run along the same lines as the proposals put forth by other Democrats and President Obama. Both of the senators from Colorado are Democrats (Mark Udall is the other Senator), and both support health care reform that includes provisions for a public health insurance options. They also both support the removal of pre-existing condition exclusions on new health insurance policies.
Senator Bennet mentioned during his Chamber of Commerce meeting that he supports initiatives that would reward doctors based on performance, measured by patient outcomes. He was asked what safeguards would be implemented to keep doctors from cherry-picking the healthiest patients under such a system, and replied that it was a good question that required more analysis. I agree that patient outcomes should be a factor in determining physician reimbursement, as should medical errors and repeat hospitalizations. But we have to take into account the patient’s health at the start of the physician/patient relationship, in addition to patient lifestyle factors. The financial incentive has to be higher, and the outcome expectations a little lower, for doctors who take on sicker patients. It doesn’t make sense to just set the bar at one level and expect doctors to get all of their patients to that level in order to get paid. A 60-year-old obese smoker with heart disease isn’t going to have the same outcomes as a 25 year-old fitness instructor with a sprained ankle, no matter how careful and efficient the doctor is.
In order to truly provide quality care, a doctor is likely going to have to spend more time with sicker patients. This should be reflected in how the doctor is compensated, along with the outcome-based incentives. There are ways to implement an outcome-based incentive system for doctors while at the same time making sure that doctors aren’t encouraged to avoid the sickest patients. I hope that this aspect of health care reform continues to be addressed and eventually makes its way into normal physician reimbursement arrangements.