Authors: Healthcare reform should start with evidencedbased financial incentives

Authors of a commentary in Circulation: Cardiovascular Quality and Outcomes are available to explain their call to change physician insurance reimbursement

Healthcare Reform should start with “evidence-based reimbursement”, structuring doctor payment incentives around existing empirical evidence of clinical benefit, which would improve quality and reduce the cost of healthcare, says a commentary written by two cardiologists and published in Circulation: Cardiovascular Quality and Outcomes.

As an example of Evidence-based Financial Incentives, the authors propose that physicians of the patients who undergo PCI be paid on a sliding scale, from $8,000 to $24,000, with the highest payments going to the physicians of patients with the most severe symptoms because the sickest patients receive the most benefit from the treatment.

“A lot of care isn’t tied directly to proof of patient benefit in clinical trials,” George Diamond MD, said. “It’s not that the care is wrong. It’s not documented to be of value. And if it’s not documented to be of value, then it should be worth less. The purpose is not to deny anybody of healthcare, but rather to funnel them to the best proven care alternatives.”

RAMIFICATIONS: Diamond and Kaul suggest empirical data could be used to determine how much physicians would be paid by Medicare and private insurers for performing specific procedures. They hope to prompt a discussion of “evidencebased
reimbursement incentives” rather than “pay for performance” among the public and policy makers. President Barack Obama has called for a national discussion of healthcare reform in the fall of 2009.