Mayo Clinic head suggests 'value scores' to reform health care. But would it work?

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In the current New England Journal of Medicine, Mayo Clinic president Dr. Denis Cortese and Board of Trustees member Dr. Jeffrey Korsmo suggest that utilizing "value scores" as a basis to prorate parts of doctors' payments from Medicare could serve as a means to "hold physicians and other providers accountable for providing high-value health care, defined in terms of both quality and cost."

In the current New England Journal of Medicine, Mayo Clinic president Dr. Denis Cortese and Board of Trustees member Dr. Jeffrey Korsmo suggest that utilizing "value scores" as a basis to prorate parts of doctors' payments from Medicare could serve as a means to "hold physicians and other providers accountable for providing high-value health care, defined in terms of both quality and cost."

By constructing scores that utilize a doctor's payment models and diagnosis history, and then making them publicly available, that doctors would have to "change their behavior - for example, sharing information and eliminating unnecessary tests - in order to increase value."

However, such reform may not be a realistic possibility under current circumstances. Recent legislation brought forward by Senator Max Baucus, a Democrat from Montana, does not include the use of "value scores" to encourage competition, but does offer ideas that have somewhat similar principles in mind.

Among the proposed reforms, primary care clinicians would receive 10 percent bonuses if more than 60 percent of their care was in the family, geriatric, internal, and pediatric fields, as well as advanced practice nurses and physician assistants, according to John K. Iglehart in a separate NEJM article.

Additionally, a national survey taken by the NEJM in early September found that U.S. physicians may not take too kindly to reforms that stress cost-effectiveness. Of 991 physicians surveyed, a combined 64 percent of respondents said they had some form of moral objection to factoring cost-effectiveness into patients' diagnoses. The survey attributed the hesitance to current Medicare legislation that puts incentive on the volume of patients instead of how they are diagnosed.

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Posted: September 24, 2009

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