January 9, 2009
Containing Costs Raises New Problems
The idea of containing health care costs by itemizing and assigning value to each task a physician does could reduce productivity, impair quality and perhaps even increase costs, according to some physicians.
In a New England Journal of Medicine "Perspective" two Beth Israel Deaconess Medical Center, Harvard Medical School physicians cite studies that suggest assigning a monetary value to every aspect of a physician's time could be self-defeating.
Pamela Hartzband, M.D., and Jerome Groopman, M.D., note that the environment in which they work has always been one where a colleague would not hesitate to stop in to offer an opinion on a complex case. They worry that if individual relative value units (RVU's, the monetary metric of physicians' time and effort) are assigned and budgeted, that environment may change. The two physicians site studies in behavioral economics and psychology that suggest this effect is plausible.
"Many physicians we know are so alienated and angered by the relentless pricing of their day that they wind up having no desire to do more than the minimum required for the financial 'bottom line,'" the authors write. "In our view, this cultural shift risks destroying some essential aspects of the medical profession that contribute to high quality health care, including pride of profession, sense of duty, altruism and collegiality."
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