A Jan. 26 report published in Forbes examines two new studies regarding how financial incentives affect surgeons' real-time decision-making.
Here are 10 takeaways:
1. The first study, a JAMA research letter, evaluated the impact of a new Medicare billing code for abdominal hernia repair that reimbursed surgeons more if the hernia was at least 3centimeters in size. Prior to the coding update, hernia size was not linked to reimbursement.
2. The JAMA study found that the percentage of patients who reported smaller, "lower-payment" hernias dropped from 60% to 49% in just one year.
3. The Forbes article speculates that surgeons were perhaps being induced to overestimate hernia size.
4. "Amibgious tasks," the researchers said in the letter, "can be conducive to perceptive bias and potentially even dishonest behavior, perhaps more so with financial incentives at play."
5. A second study examined commercial and Medicare-age members of Michigan's Blue Cross and Blue Shield plan. It sought to find out whether a coding change could induce more urologists to follow medical evidence on low-risk prostate cancer and adopt "active surveillance," formerly known as "watchful waiting," as opposed to biopsies and surgery.
6. The study, which evaluated 15,000 commercial and Medicare-age members of the state's Blue Cross and Blue Shield plan, found that the payment incentive was not associated with increased surveillance among patients with low-risk prostate cancer.
7. The Forbes article highlights the researchers' conclusion that surgical treatment decisions are often swayed by financial incentives. For example, "physicians may make thousands of dollars more in the first year through primary treatment, as opposed to active surveillance."
8. Additionally, for any individual surgeon in the study to receive the health plan's financial incentive, the entire urology group had to meet a target of almost 75% of men eligible for active surveillance to have it offered to them or to accept it as a treatment plan.
9. The article questions the healthcare system's progress toward "value-based payment" being espoused by payers, providers and policymakers.
10. "When a new billing code pays more to individual surgeons, significant change swiftly follows, even if only in documentation," reads the Forbes article. "Roll out a convoluted payment scheme that requires an entire surgical group to alter its doctors' actually practice, however, and very little happens."