Last week I spoke with Anne Underwood of the New York Times for a Prescriptions Blog entry she was writing about physician payment based on quality. In the interview, I discuss with her the inherent problems of the fee-for-service system and how virtual quality networks could change the way we practice medicine. I encourage you to check it out. However, you need to know that a lot of what I said was not included -- that many smaller and non-integrated practices produce very high quality; and that some integrated systems do not.

A lot of folks thought this showed ACC leadership in leading the quality and payment reform debate, but some did not (and I can see why, given what was edited out). One ACC member, David Perloff, M.D., F.A.C.C., thoughtfully objected to the comment: “Doctors get rewarded for more tests, more volume, more hospital admissions, more visits in the current system.” Dr. Perloff believes comments like these “make cardiologists out to be money-motivated opportunists who simply over-order tests to make more money!” He believes that instead we should “counter these accusations by insisting that, in general, our test ordering is based on either appropriate guidelines or because we are forced to over-order tests to protect us from a broken liability system.” Too bad he wasn’t able to hear my entire interview.

I am in complete agreement with Dr Perloff. Most cardiologists -- indeed most physicians -- are motivated by their patients’ needs. But, our payment system and our physician liability system are fundamentally flawed. And, frankly, everybody is not as conscientious as he and the ACC are about this. But, the Congress, along with many supportive consumer, union, and employer groups, are pushing to eliminate or greatly reduce fee for service and replace it with the Harvard Business School longstanding proposal for reward better outcomes, evidence based care, and efficiency. We better make sure such future systems are designed by physicians and organizations like the ACC -- and not those who are only ‘playing doctor’ in the policy agenda.

If you've read the interview, I'd like to hear your thoughts. Leave a comment below.

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