Suggested payment model is unworkable

January 25, 2014

Reader opinion: A reader writes to disagree with a proposed pay model designed to reward quality.

KJ Lee, MD’s payment ideas in his article, “New payment models should reward quality” (November 25, 2013) are the worst since subprime mortgage loans. The concept that physicians should be paid 60% of their fee first and the remaining 40% be dispersed quarterly and based on “metrics and outcome measures” is ridiculous and insulting.

As a family practice doctor it is a constant struggle to get my maximum allowable fee (average $60--including copay!) from the insurance companies already. Now Lee wants me to get reimbursed 60% of that pittance and have to jump through hoops to get the remaining 40%? The billing procedure is burdensome enough, fraught with paperwork, denials, preexisting conditions forms, and more. Now add “metrics and outcome measures” as another reason for denial of payment to the stew of reasons to get that explanation of benefits without a check in it?

As a professor of surgery, Lee should test his theory by taking only 60% of his salary, forgoing the other 40% until his students have graduated, passed their surgical boards, had their surgeries discussed at grand rounds and the surgical patients outcomes followed quarterly. Now that is a great idea.

 Lee Morgentaler, DO

Old Tappan, New York

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