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New call for 'drastic changes' in how Medicare pays doctors

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    Reaction from Dr. Marc Siegel

  • Duration 4:56
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A growing health care debate now after a major medical group unveils a dramatic new plan.

For dealing with a significant shortfall in the nation's Medicare system.

Is basically talking about how doctors -- gonna get paid for taking care -- our seniors and some others.

They -- calling for quote drastic changes in the way doctors and other health care providers.

Are going to get paid and that affects you.

Doctor Mark Siegel is a member of Arafat is -- -- also an associate professor of medicine at NYU's lingo known medical center -- All right so this is a group of physicians and others who get together and say -- we're not paying doctors in the right way back to improve the way we pay them and they want to reward.

Value.

Not volume so what are they gonna do to assess how well you do in treating your patience and adjust your payment according.

In a word yes national commission on physician payment reform it's a bunch of general -- a bunch of primary care doctors like me.

And they're saying in this part is right they're saying there's a lot of waste in the system there's doctors over ordering tests.

Over ordering procedures -- ordering surgeries there's no brakes on it there's no way to control it.

It's a lot of waste and they're saying let's reward quality and by the way this is the whole thrust one of the thrust of Obama care.

Let's put in more regulations let's try to reward.

Doctors for for doing what's called quality medicine but but there's a big downside to this first of all who's gonna determine this second of all.

Doctors -- -- cherry pick their patients doctors are gonna say I don't want that patient too many problems can't be efficient -- that patient.

Things keep going along he calls and in -- volume category got a government ought to keep coming back to me every week I can't make them better their sickness took -- I'm going to be penalized.

And then surgeons are gonna -- I trained ten years fifteen years to do this high tech solution and they're not paying me forward anymore want to go to school for all of that.

I got to be the best doctor in the country at a given procedure what do you -- -- -- import anymore they're saying we we will gonna get we're gonna pay you we're just gonna incentivize -- to.

To bring value to the process as -- to turn -- and burn.

Because -- there's something called bundling payments that they're gonna do as part of this and I like it conceptually I don't like in the real world what is bundling payments mean.

It means somebody goes in for a surgery.

But when they're dealt with the surgery.

They're still in the hospital -- getting fatigued and not sleeping right to get an infection and instead of paying for each of those things they give you one big payment for all of it.

But the problem that you could see what the problem is the surgeon is paid for the procedure they do but the gonna take that away they're gonna say we're gonna pay you for the whole hospital -- -- And so he only he or she only gets a share now all that's right price pie that's right the team will get paid.

It's good for the team concept but I think it's bad for quality medicine -- spared for high tech solutions and and that's of course the direction we're going and in this country.

You know with all kinds of new techniques we have what.

The things they talk about is how that there are certain that so many things messed up about our medical system in the way we pay the doctors and so on -- -- we charge the patients.

But they they offered this example they said okay Medicare for example.

If you get a an echo an echo cardiogram like an ultrasound of your heart.

In a hospital.

Medicare will pay 450 dollars but you get your doctor's office they'll only pay a 180 dollars.

And one of the doctors on this panel said there is no reason for that whatsoever we have to find ways.

Of ED inning that out so that you know patients don't have an incentive doctors and have an incentive to do one place -- -- the other and I mean.

It seem like -- can be.

Some.

Access to the system -- -- excuse my -- when -- my hospital has to excuse me for saying this but that when I like.

That what I like I think there should be uniform payment for procedure no matter where you -- -- -- hospital the doctors all of us.

That's -- I like the problem I have is what.

Determining qualities who always going to determine if -- being efficient but can't get that term.

Well some board like this is gonna determine that some obamacare board is gonna determine it and I don't think they're good -- -- you don't want.

I like it when I'm inefficient but I come to the right answer sometimes takes me awhile to think of what the right answers.

I don't want that to be extinguished I don't want it to be extinct.

Doctors are artists are what they do if we I don't I think we need to be more efficient but if it's a matter of being under about a big -- -- regulations it's gonna.

Hurt the US one of the things quickly they had don't you like higher -- -- that you like that because it's -- -- forces the patients have skin in the finance.

Exactly obamacare is going in the opposite direction I want more -- is that what we're deductibles -- one health savings accounts -- want the patient to have to pay for basic nonessential service now which would decrease some of that -- that we start asking where we should start practicing a thank you sector this -- Takes them awhile to think of it that -- really just being humble modest -- like daddy gets I would.

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