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How do cardiologists want to get paid?

According to the American College of Cardiology, here’s what you get when you ask nearly 400 of ’em: Nearly two-thirds (63%) of cardiologists in private practices are currently compensated on a fee-for-service basis (FFS) exclusively; and, similarly, nearly two-thirds (65%) of these private practice cardiologists indicate that their ideal compensation is fee-for-service. Some of this […]

According to the American College of Cardiology, here’s what you get when you ask nearly 400 of ’em:

Nearly two-thirds (63%) of cardiologists in private practices are currently compensated on a fee-for-service basis (FFS) exclusively; and, similarly, nearly two-thirds (65%) of these private practice cardiologists indicate that their ideal compensation is fee-for-service. Some of this response seems to be related to fear that doctors are due to be shafted regardless of what form of reimbursement is used. Therefore stick with the devil you know — even if it is constantly declining.

Conversely, more than three-fourths (78%) of the cardiologists who are not in private practice currently receive a salary as their primary source of income. However, interesting to note is that only 57% of these cardiologists state that a salary is their ideal form of compensation. Fee-for-service (19%) and a mixed compensation system (22%) actually gain strength among them for ideal compensation. This makes sense. Salaried cardiologists deserve incentives for productivity (everybody doesn’t work as hard) and quality (everybody doesn’t strive as effectively for better outcomes). Incentives have to be based on relevant data comparisons—not conjecture.

In my view, fee-for-service is effectively (and appropriately) on life-support and fading fast. Oh sure, “concierge” fees can make up a difference between medicare payments and drops in fees for a while in affluent areas, but these fees do nothing to address the very real needs for doctors in less affluent or rural health care delivery areas. On first blush, the market is moving to a health care system salary-based structure, but straight salaries do little to promote team collaboration nor reward exceptional personal effort. If productivity incentives are added to straight salary structures, there is a risk of promoting of even more testing to benefit the hospital (and hence employee-doctor’s) bottom line at the expense of the patient or their insurer.

Of course the whole damn physician payment mess is complicated by a billing coding scheme that is so ridiculous, arbitrary, and insane that no matter which method you pick, it can be gamed to everyone’s benefit except the patient. Get rid of THAT system and we might be able to talk about REAL physician payment reform.

How?

Pay ALL doctors, be they specialists or not, a fair, market-based hourly wage for work performed. That’s ALL work: from the most mundane e-mail response or medication refill to the most time-consuming history-taking or complex neurosurgical procedure. Pay them time-and-a-quarter or time-and-a-half for after hours duty.

Since most of our legislature are lawyers, even they should understand this concept, right?

Imagine: no diagnosis codes, no procedure codes, no coding specialists, no 500,000 permutations and combinations of procedure codes that must match pre-determined and frequently varying diagnosis codes. If hospitals and government want to screw with that system – go for it – but keep the physician workforce separate from these coding shenanigans. Pay us what our time and intellectual capabilities are worth. Period.

And what might these hourly wages be?

That would have to be worked out based on training, years of practice, malpractice risk, board-certification, etc. But compared to the mess we have now, I’m betting this system would be a whole hell-of-a-lot more understandable and transparent than the monkey business we’re doing now.

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005. He writes regularly at Dr. Wes. DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.

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