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Thursday, January 11, 2018

Perverse Incentives: Do You See What I See? - PulmCCM

Recently, a 91-year-old relative had a serious intracerebral hemorrhage, but recovered miraculously. It is really hard for him to get around, but he always goes for an annual checkup. His stroke wasn't going to stop him from his routine.

During the visit, his physician told him that the office x-ray equipment wasn't working, and that he needed to return in 2 weeks for his routine annual chest x-ray (which was normal during his recent stroke). When I heard the story, I told him that the x-ray wasn't needed. He didn't need to make special arrangements to return to the office.

So he asked: "Why would a physician ask me to return for a test that I didn't need?"

Good question. Why do physicians check the serum cholesterol in women who have advanced ovarian cancer?

Too many physicians order tests and recommend procedures primarily because they can be paid to do them.

Many healthcare practices -- and entire health systems -- focus on generating revenues in every possible way. The goal is to eke out every dollar from every patient interaction. In many instances, it means encouraging patients to undergo tests and procedures that are not needed but will be reimbursed.

This obsession with revenues is destroying medicine.


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