A Possible Prescription for Better Public Health Care

We judge the effectiveness of teachers by how their students perform in school; police officers by how well they fight crime; firefighters by how quickly they reach the scene of a fire.Why not do the same with doctors?

With medical costs skyrocketing, and our public health-care system on the verge of collapsing in the face of the spiraling expense of hospitalization, it is vital that we find a way to provide quality care and hold down expenditures. If projections hold true, the U.S. health-care system will consume some $4 trillion in 2020, or 20 percent of the GDP.

The Health and Hospitals Corporation’s proposal to tie doctors’ compensation to patient outcomes is an idea worth considering. The corporation oversees 11 hospitals in the city, including Bellevue, Coney Island, Kings County and Elmhurst hospitals.

Under New York City’s current public hospital system, doctors’ pay is linked to the amount of care and services they provide. In other words, if physicians see more patients and order more tests, they get fatter pay checks. That gives them the financial incentive to examine as many patients as possible and subject them to batteries of tests.

Without correlating patient outcome with patient care, too many doctors practice defensive medicine. This entails ordering as many tests as possible, even when it is improbable that testing will reveal any positive — not to mention conclusive — results. Some of these tests may even produce false positives which would, in turn, cause the patient to be subjected to procedures of marginal clinical value or to a painful biopsy. While most doctors only want the best for their patients, the ease with which they can order expensive tests such as CAT scans, MRIs and cardiac stress tests — without thinking of the costs — translates into higher pay and lower chance of malpractice.

This has to change. Allowing doctors to work on what amounts to commission fuels health-care costs. According to a report by the Congressional Budget Office in 2012, approximately 30 percent of U.S. health-care costs, or more than $500 billion, is wasted on unnecessary tests, hospital stays and procedures. Not only are unneeded tests a terrific waste of money, but the high doses of radiation produced by some may actually be harmful to the patient.

In fact, nine medical societies, including the American College of Cardiology, now question the use of tests for many symptoms and screenings, including imaging for back pain, brain scans for fainting and routine colonoscopies. In a report last year, the American College of Physicians listed 37 tests it judged to be overused or unnecessary. In a Consumer Reports poll, 44 percent of those between the ages of 40 and 60 said that they underwent a cardiogram or a stress test, despite having no symptoms or risk factors.

Making sure doctors think twice before they send patients for tests makes all the more sense in the public health-care system, where many of those using the system are indigent, poorly educated and immigrants. For such patients it is much harder, if not impossible, to question their health-care providers on whether the treatment they are receiving is the most appropriate one.

If the proposal passes, good communication will be one of the points used to judge performance. Doctors will also be rated on how many patients are readmitted with pneumonia and heart disease. Anyone who has had to spend countless hours in a public hospital emergency room waiting for a bed or proper care will be pleased to know that doctors will be held accountable for that amount of time as well.

Public hospital doctors may not like having their salary linked to results, but such linkage of income to performance is already going into effect under ObamaCare, or the Affordable Care Act. Hospitals will receive more or less money based on how they rank in various performance metrics. They are going to be responsible for rates of preventable infection, unnecessary hospital stays and high readmission rates. When doctors have their eye on patient outcomes, the shotgun approach to medicine will be replaced by one more measured and aligned with quality care.

The value of health shouldn’t have a price tag attached to it, but where unnecessary tests and procedures are driving up the costs of health care and inflicting harm on patients, we should not fear to demand more accountability from our hospitals and doctors.