MASSACHUSETTS: Group to Fine MDs for ‘Unnecessary’ Care
In an "extremely rare" move, a Cambridge physician group plans to penalize individual physicians $250 for each day of a patient's hospital stay deemed "not medically necessary," a cost-cutting tactic opponents are calling "immoral." The Boston Globe reports the fine, which will apply to 350 doctors in the Mount Auburn Cambridge Independent Practice Association as of Nov. 1, is drawing fire from local and national critics because it will target individual physicians, while the vast majority of physician incentive plans -- and the type recognized by AMA policy -- focus on the performance of physician groups. A Sept. 23 internal IPA memo, obtained by the Globe, outlines the penalty system: Case managers will review hospital admissions records to identify unnecessary stays and contact "offending" physicians to offer "alternative treatment plans." If a doctor and case manager disagree on a patient's appropriate course of care, a physician panel in the Mount Auburn practice will decide "whether to dun the physician."
Dr. Robert Jannett, medical director of the physician group, defended the strategy, argued that the practice is simply attempting to reduce waste and improve care by penalizing "ineffective clinical decision making." Dr. Rob Jannett said, "I'm Dr. Efficiency, and I'm controversial for it. But I believe it's the right thing to do." But group physicians said the fines will have a "chilling effect" on their decisions and may preclude them from providing care with their patients' best interests in mind, particularly in borderline cases. Medical ethicists believe the penalty is "too punitive," and one physician critical of financial incentive plans called the policy "absolutely disquieting," arguing it will "erode patients' trust" in physicians. Dr. David Himmelstein, internist at the IPA, said, "It's pushing the envelope. We've been bordering on the immoral for a long time. This ... goes over that edge. I'm horrified, but not surprised." Dr. Steven Pearson, associate director of the Center for Medical Ethics in Managed Care at Harvard Medical School, said, "They're going to be skating on thin ice with patients and the public, in my opinion."
The Globe reports that the new policy is but another episode in the broader fight to eliminate wasteful health care spending. Proponents of bold measures to reduce unnecessary hospitalization point to California -- long a bellwether for other states grappling with managed care -- where physicians tend to rely less on hospital care. According to an American Health Association survey, the number of hospital days per 1,000 residents in the Golden State was 499.5, compared to 700.1 in Massachusetts -- a difference some view as an indication that there is room to reduce hospitalization in the Bay State. But others note that Massachusetts ranks below the national average of 719.3 hospital days per 1,000 residents, despite the fact that the state's teaching hospitals provide care for some of the sickest patients in the nation (Pham, 10/14).