Dartmouth researcher says the way doctors are paid should change

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(Host) A Dartmouth researcher has a plan that would dramatically change the way health care providers are paid in this country.

As VPR’s Bob Kinzel reports, the researcher says his plan would significantly reduce the number of unnecessary procedures, and would free up money to expand health care everyone.

(Kinzel) Dr. Elliot Fisher is the director of the Center of Health Policy Services at Dartmouth College. For the past 25 years he and his colleagues have been studying the link between health care costs and the quality of care that’s being delivered.

Their conclusions are surprising and have become the focal point for payment reform efforts in Congress.

Speaking on VPR’s Vermont Edition, Fisher says regions of the country that spend twice as much per capita on health care as other regions, don’t have better patient outcomes and in some cases the outcomes are worse.

Fisher thinks the current "fee for service" payment system – a system that reimburses physicians for every office visit, every test and every procedure – is at the heart of the problem:

(Fisher) "So this is a dynamic system that is really set up to achieve poor results. And that’s some of the insight of our work. That is, if you think about how we’re paying people, how fragmented the care is, if we think about new ways of paying that would reward better care and better health at a lower cost, we might get what we want from our health care system."

(Kinzel) Fisher says between 30 and 50 percent of all primary care office visits are unnecessary because the work could be done over the phone or using the Internet. But he says the current system doesn’t pay doctors for providing these types of services:

(Fisher) "The thing to understand is that the fee for service payment is part of the problem here. Because they only make their revenue by seeing patients in their offices – have to see you in their office – and there’s a lot of unnecessary care that’s generated."

(Kinzel) Fisher says the solution is creating regional accountable care organizations. These are local groups that would consist of hospitals, primary care physicians and specialists.

He says health care providers in these groups would be reimbursed based on the outcomes of their patients instead of using the fee for service model.

(Fisher) "So if you think about reform that moved toward different ways of paying primary care physicians or different ways of paying for health care overall, you could eliminate a lot of unnecessary services and provide many more of the important services that we know will improve health."

(Kinzel) Many of Fisher’s recommendations are included in new legislation that’s co-sponsored by Congressman Peter Welch.

For VPR News I’m Bob Kinzel in Montpelier

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