This article reviews the new approach, explores provider perceptions; and discusses opportunities for the future. For decades, health systems and physician practice groups in the United States have tended to employ variations on one of two basic models for compensating physicians: a salary paid largely irrespective of clinical volumes, or a modest base salary plus a significant percentage of fee-for-service (FFS) revenues associated with each clinical encounter.
The salary model may incentivize low productivity, while the FFS approach can lead doctors to over-provide procedures. But momentum is growing to apply new financing models that provide stronger incentives for quality, efficiency, and patient satisfaction.
UnitedHealth Group, for example, reported earlier this year that nearly 60% of the insurer’s $130 billion in annual medical spending is value-based models. At UC San Diego, the new payment rules spurred the hospital to introduce campaigns to improve quality and promote best practices, such as appropriate use of antibiotics and blood clot prevention medication prior to surgery.
“It immediately changed what hospitals did, including ours.” says Sonia Ramamoorthy, Chief of the Division of Colon and Rectal Surgery and Vice Chair for Quality. “It changed things in a way that just making suggestions to providers in health systems had minimal impact.
Following its introduction, volume promptly rose, such that today, nearly every surgeon in the Department is above national median productivity. In April 2015, the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRO) effectively repealed the sustainable growth rate formula that measures increases to provider payments against changes in GDP.
MACRO will eventually form the largest value-based purchasing program in the United States. For fiscal year 2019, hospital departments at UC San Diego were tasked with introducing compensation plans that require at least 1 percent of physician pay to be tied to performance on quality indicators.
Department of Surgery indicators are a mix of process and outcome measures, some of which have targets to achieve, while others are all or nothing. Although performance is measured at the level of the division, the incentive targets each individual surgeon.
One percent of their income is withheld throughout the year, and then “earned back” according to their division’s performance on quality. To qualify for receipt of the full 1 percent withheld, a physicians’ divisions must meet targets for all three indicators.
“It can be difficult to gain traction for quality programs because physicians see them as punitive, and a lot of extra work, when surgeons already have so much on their plates.” Sonia Ramamoorthy Chief, Division of Colon and Rectal Surgery But some think the shift may be needed anyway.
Making it meaningful will require more conversation about what is the best incentive approach, and which measures of quality and outcomes are most appropriate. Because pay for performance schemes rely heavily on data, strengthening health information management systems is also important.
Doctors generally earn a high salary, but you may be wondering how much surgeons earn since they are highly educated to specialize in one major form of medical treatment such as surgery or cutting the body to remove or repair a tissue. However, in another CNN Money feature, general surgeons ranked second place in the “20 Highest-Paying Jobs”.
Some diseases that pediatric surgeons deal with are congenital malformations such as cleft lip and palate, abdominal wall defects, chest wall deformities, childhood tumors and separation of conjoined twins. Gynecological surgeons or gynecologists perform surgery on the female reproductive system.
Women who have problems with cancer in the reproduction system, infertility and incontinence go to gynecologists for advice. There are many types of cancer that require the oncologists to specialize in surgical management of all benign diseases.
Bariatric surgery is performed for obese people with a body mass index (BMI) of 35 or 40 with or without diabetes. Oral surgeons perform surgery to the head, mouth, teeth, gums, jaw and neck.
The type of surgery or treatment performed to patients with injuries or effects involving the parts mentioned are wisdom teeth removal, corrective jaw surgery, oral pathology, dental implants and facial trauma and more. In Europe, oral surgeons are required to take three additional years of training after graduating from the dentistry program.
Plastic surgeons specialize in a medical procedure to correct or restore form and function. Medical history relates that the Indian physician Sushmita, dubbed as “the father of surgery largely contributed important medical works in the fields of plastic and cataract surgery in 6th century B.C.
John Better Better was the first American plastic surgeon who performed the first cleft palate surgery. A neurosurgeon performs surgeries to the nervous system that includes the spinal cord, peripheral nerves, brain and skull.
The basic requirement for becoming a neurosurgeon is to have a bachelor’s degree in pre-med or in biological, chemical or physical science. Cardiac surgeons go through an extensive training before they can earn their title and start performing surgeries.
In the undergraduate level, there is no specific degree required, but it would be best to take pre-med courses before going to graduate school for further training in medicine. They can use surgical and non-surgical means to treat patients with sports injuries, infections, tumors, congenital disorders and many others that are related or affected the musculoskeletal system.