{"id":3408,"date":"2025-01-30T07:48:00","date_gmt":"2025-01-30T07:48:00","guid":{"rendered":"https:\/\/medical-article.com\/?p=3408"},"modified":"2025-01-30T07:48:00","modified_gmt":"2025-01-30T07:48:00","slug":"its-money-that-changes-everything-or-doesnt-for-surgeons","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=3408","title":{"rendered":"It\u2019s Money That Changes Everything (Or Doesn\u2019t) For Surgeons"},"content":{"rendered":"
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By MICHAEL MILLENSON<\/p>\n

\u201cMoney changes everything<\/a>,\u201d Cyndi Lauper famously sang about love to a pulsating rock \u2018n\u2019 roll beat. So, too, when it comes to financial incentives for surgeons, two new studies suggest, although \u201cHow much money?\u201d and \u201cWhat do I have to do?\u201d are the keys to unlocking monetary motivation.<\/p>\n

The first study, a JAMA<\/em> research letter, examined the impact of a new Medicare billing code for abdominal hernia repair that paid surgeons more if the hernia measured at least 3 centimeters in size. Previously, \u201csize was not linked to hernia reimbursement,\u201d noted University of Michigan researchers.<\/p>\n

Surprise! The percentage of patients said to have smaller, lower-payment hernias dropped from 60% to 49% in just one year. Were \u201csmall hernia\u201d patients being denied care? Nope. Were surgeons perhaps more precise in measuring hernia size? Maybe. Or possibly, wrote the researchers in careful academic language, \u201cthe coding change may have induced surgeons to overestimate hernia size.\u201d Ambiguous tasks, they added, \u201ccan be conducive to perceptive [cq] bias and potentially even dishonest behavior, perhaps more so with financial incentives at play.\u201d<\/p>\n

This being an academic publication, two footnotes informed us that dangling money in front of our eyes can cause people to \u201csee what you want to see\u201d and come up with an \u201celastic justification\u201d for truth.<\/p>\n

If a simple coding change can apparently boost the number of large-hernia patients by 18% in just one year, what about a payment incentive meant to induce more urologists to follow the medical evidence on low-risk prostate cancer and adopt \u201cactive surveillance\u201d (formerly known as \u201cwatchful waiting\u201d), rather putting patients through a painful and expensive regimen of biopsies and surgery?<\/p>\n

\n<\/div>\n

A second study, also in Michigan, involved commercial and Medicare-age members of the state\u2019s Blue Cross and Blue Shield plan. However, after three years and more than 15,000 patients, \u201cthe payment incentive was not associated with increased surveillance use among patients with low-risk disease,\u201d researchers concluded<\/a> in a JAMA Network Open<\/em> article.<\/p>\n

<\/span><\/p>\n

A financial incentive fails<\/strong><\/h2>\n

This inertia belied the enormous potential for improvement. A previous study found<\/a> active surveillance for low-risk prostate cancer patients among Michigan urology groups \u2013 a rate adjusted for the patient\u2019s clinical condition \u2013 ranged from 30% to 73%. In one urology practice, the rate among individual clinicians \u2013 a half-century after the first studies<\/a> of practice variation practice variation among similar doctors with similar patients \u2013 ranged from zero to 96%!<\/p>\n

Yet even in those physician groups with the lowest rate of active surveillance use and the highest proportion of patients from Blue Cross \u2013 the groups expected to be most \u201csensitive\u201d to a financial incentive \u2013 there was no statistically significant change. Why?<\/p>\n

Once again, the researchers carefully noted that surgical treatment decisions \u201cmay be partly driven by nonclinical factors, including financial incentives.\u201d For instance, \u201cphysicians may make thousands of dollars more in the first year through primary treatment as opposed to active surveillance.\u201d Moreover, for any individual surgeon to actually receive the health plan\u2019s financial incentive, the entire urology group had to meet a target requiring almost three-quarters of men eligible for active surveillance to either be offered it as an option or accept it.<\/p>\n

For all the loud proclamations by payers, providers and policymakers that the U.S. healthcare care system is well on its way to \u201cvalue-based payment,\u201d the pronouncements about an emphasis on patient preferences and the \u201ccost-quality equation\u201d remain just that empty words when compared to the concrete value signified by an immediate paycheck boost. When a new billing code pays more to individual surgeons, significant change swiftly follows, even if only in documentation. Roll out a convoluted payment scheme that requires an entire surgical group to alter its doctors actually practice, however, and very little happens.<\/p>\n

The \u201ceffective\u201d way \u201cto align prostate cancer care quality with payment,\u201d the researchers concluded, may require \u201creimbursement parity between [low-risk prostate cancer] management strategies.\u201d<\/p>\n

In other words, if you want financial incentives for surgeons to really work, it pays to remember a declaration a Tom Cruise film made famous: \u201cShow me the money<\/a>.\u201d<\/p>\n

Michael L. Millenson is president of Health Quality Advisors & a regular THCB Contributor<\/em>. This originally appeared on Forbes<\/a>.<\/em><\/p>","protected":false},"excerpt":{"rendered":"

By MICHAEL MILLENSON \u201cMoney changes everything,\u201d Cyndi Lauper famously sang about love to a pulsating rock \u2018n\u2019 roll beat. So, too, when it comes to financial incentives for surgeons, two new studies suggest, although \u201cHow much money?\u201d and \u201cWhat do I have to do?\u201d are the keys to unlocking monetary motivation. The first study, a…<\/p>\n","protected":false},"author":0,"featured_media":3407,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-3408","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/3408"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3408"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/3408\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/3407"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3408"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3408"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3408"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}