Title: The Impact of Wealth on Surgeons: A Double-Edged Sword
Money truly holds sway over various aspects of life, as sung by Cyndi Lauper. This fact holds particularly true when it comes to financial incentives for surgeons, according to two new studies. The million-dollar question here is, "How much money?" and "What actions need to be taken?" to motivate surgeons financially.
The first study, published in JAMA, scrutinized the influence of a new Medicare billing code that rewarded surgeons more for abdominal hernia repairs measuring at least 3 centimeters. Previously, the size of the hernia wasn't tied to the compensation. What followed was a fascinating shift – the percentage of smaller hernia patients decreased from 60% to 49% within just a year. Were patients denied access to care due to smaller hernias? Not likely. Perhaps surgeons became more precise in measuring hernia size or the coding change inadvertently induced surgeons to inflate hernia size measurements, as the researchers suggested. Ambiguity in such tasks often opens the door for biased perception and potentially dishonest behavior when financial incentives are at play.
Dangling cash in front of our eyes has a remarkable effect, as academic articles have shown: it can lead us to focus on certain aspects and create justifications that may seem elastic in nature. This links us to the second study, which took place in Michigan and focused on commercial and Medicare-aged members of Blue Cross and Blue Shield.
The researchers aimed to encourage more urologists to adhere to the medical evidence regarding low-risk prostate cancer and use active surveillance (previously known as "watchful waiting") instead of putting patients through biopsies and surgeries. Regrettably, the payment incentive failed to significantly increase surveillance use among individuals with low-risk disease, after three years and over 15,000 patients.
Despite this discouraging result, the potential for improvement was vast. A prior study carried out in Michigan uncovered a significant disparity in the adoption of active surveillance within the community, with the rate of usage among low-risk prostate cancer patients ranging from 30% to 73%, with few practices achieving over 50% adherence.
Despite the expectation that the financial incentive would yield a substantial change in one of the participating physician groups known for low surveillance usage and high Blue Cross enrollment, no statistically significant change occurred. The researchers attributed this to possibly nonclinical factors, such as surgeons preferring primary treatment to active surveillance due to greater financial rewards in the short term, as well as the requirement for nearly three-quarters of eligible men to be offered or accept active surveillance for the incentive to be received by the entire surgical group.
In conclusion, financial incentives may not always reliably alter surgeons' practices. In order to see real change, it's essential to remember the famous phrase from a Tom Cruise film: "Show me the money." This implies calling for reimbursement parity between management strategies for low-risk prostate cancer to truly make financial incentives work.
- The first study examined the impact of a new Medicare billing code for 'hernia surgery', offering higher payments for larger hernias, leading to a decrease in smaller hernia patients.
- In an attempt to promote 'active surveillance' for low-risk prostate cancer, a payment incentive was implemented in Michigan, but it failed to significantly increase its use among patients.
- The lack of significant change in surgeons' practices due to financial incentives highlights the need for 'value-based payment' policies, ensuring equitable reimbursement for different management strategies for low-risk prostate cancer.
- Ambiguity in tasks, such as measuring hernia size, can lead to 'upcoding' when financial incentives are at play, potentially causing surgeons to inadvertently inflate measurements.
