{"id":2504,"date":"2014-12-11T14:20:38","date_gmt":"2014-12-11T03:20:38","guid":{"rendered":"http:\/\/blog.panicola.com\/?p=2504"},"modified":"2014-12-11T14:20:38","modified_gmt":"2014-12-11T03:20:38","slug":"how-medical-care-is-being-corrupted","status":"publish","type":"post","link":"https:\/\/blog.panicola.com\/?p=2504","title":{"rendered":"How Medical Care Is Being Corrupted"},"content":{"rendered":"

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http:\/\/www.nytimes.com\/2014\/11\/19\/opinion\/how-medical-care-is-being-corrupted.html?_r=0<\/p>\n

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How Medical Care Is Being Corrupted<\/h1>\n
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By PAMELA HARTZBAND<\/span> and <\/span>JEROME GROOPMAN\u00a0<\/span><\/span>

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Credit<\/span>Alex Merto<\/span><\/figcaption><\/figure>\n
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WHEN we are patients, we want our doctors to make recommendations that are in our best interests as individuals. As physicians, we strive to do the same for our patients.<\/p>\n

But financial forces largely hidden from the public are beginning to corrupt care and undermine the bond of trust between doctors and patients. Insurers, hospital networks and regulatory groups have put in place both rewards and punishments that can powerfully influence your doctor\u2019s decisions.<\/p>\n

Contracts for medical care that incorporate \u201cpay for performance\u201d direct physicians to meet strict metrics for testing and treatment. These metrics are population-based and generic, and do not take into account the individual characteristics and preferences of the patient or differing expert opinions on optimal practice.<\/p>\n

For example, doctors are rewarded for keeping their patients\u2019 cholesterol and blood pressure below certain target levels. For some patients, this is good medicine, but for others the benefits may not outweigh the risks. Treatment with drugs such as statins can cause significant side effects, including muscle pain and increased risk of diabetes. Blood-pressure therapy to meet an imposed target may lead to increased falls and fractures in older patients.<\/p>\n

Physicians who meet their designated targets are not only rewarded with a bonus from the insurer but are also given high ratings on insurer websites. Physicians who deviate from such metrics are financially penalized through lower payments and are publicly shamed, listed on insurer websites in a lower tier. Further, their patients may be required to pay higher co-payments.<\/p>\n

These measures are clearly designed to coerce physicians to comply with the metrics. Thus doctors may feel pressured to withhold treatment that they feel is required or feel forced to recommend treatment whose risks may outweigh benefits.<\/p>\n

It is not just treatment targets but also the particular medications to be used that are now often dictated by insurers. Commonly this is done by assigning a larger co-payment to certain drugs, a negative incentive for patients to choose higher-cost medications. But now some insurers are offering a positive financial incentive directly to physicians to use specific medications. For example, WellPoint, one of the largest private payers for health care, recently outlined designated treatment pathways for cancer and announced that it would pay physicians an incentive of $350 per month per patient treated on the designated pathway.<\/p>\n

This has raised concern in the oncology community because there is considerable debate among experts about what is optimal. Dr. Margaret A. Tempero of the National Comprehensive Cancer Network observed that every day oncologists saw patients for whom deviation from treatment guidelines made sense: \u201cWill oncologists be reluctant to make these decisions because of an adverse effects on payments?\u201d Further, some health care networks limit the ability of a patient to get a second opinion by going outside the network. The patient is financially penalized with large co-payments or no coverage at all. Additionally, the physician who refers the patient out of network risks censure from the network administration.<\/p>\n

When a patient asks \u201cIs this treatment right for me?\u201d the doctor faces a potential moral dilemma. How should he answer if the response is to his personal detriment? Some health policy experts suggest that there is no moral dilemma. They argue that it is obsolete for the doctor to approach each patient strictly as an individual; medical decisions should be made on the basis of what is best for the population as a whole.<\/p>\n