According to Dr. Berwick who was recently given a recess appointment by President Obama to head CMS (centers for Medicare and Medicaid), a “pay-for-performance” program will decrease the cost of healthcare. This statement comes from someone who spent most of his career as an academician, not a practicing physician as his pediatric training would suggest.
More troubling is that deviation from guidelines being set will be construed as insurance fraud, thereby making physicians criminals.
So, let’s take a closer look at this. If a doctor evaluates you and decides that a particular medical option would be in your best interest and it is not on the regular guidelines that makes him a criminal? Now it makes him vulnerable to fines and jail time?
More frightening still is that state insurance administrators are establishing guidelines. These people are basing their decision on economics not sound medical options. It was not so long ago that I was told by insurance personnel, “ we are not trained in medicine”. “When we reject treatment reimbursement for a patient being pre-certified, it is not because of the need, it is because we don’t feel that it is something that we should pay for. If you feel that the patient needs a particular treatment and you don’t recommend it, you are totally liable!”
In Massachusetts, Obama’s healthcare model purports to say that doctors who don’t comply with the structure established by state insurance administrators will be publicly discredited and harassed while the patients will be required to pay out of pocket at triple the cost.
This seems that it is not only the physicians who are damned. It is the public….you and me!