Right now, doctors and hospitals mainly get paid for each individual test and procedure they perform — a system known as fee-for-service.
- There’s a broad consensus that model doesn’t work very well, and should shift to a more value-based model. Geisinger, the large, integrated health system headquartered in Pennsylvania, is often held up as an example of how that could work.
- But of course some people want to go even further — to a single-payer system.
Flashback: Former President Obama once hailed Geisinger — which owns hospitals, an insurance company and physicians’ practices — as a model of the more integrated, “value-based” system he wanted to help build.
But, but, but: My colleague Bob Herman noticed a recent financial statement in which the system said it "seeks to grow high-acuity, fee-for-service business.”
- Why? "We recognize that not everybody is going to have Geisinger Health Plan," Geisinger chief financial officer Kevin Brennan told Bob, referring to the system's insurance company. "We want to make sure that we don't ignore them and want to welcome and treat them regardless of their insurance source. It's growth and market share that's the most important."
- He also said physicians don't get higher paychecks if there are more admissions.
What’s next: There are efforts under way to shift to a more integrated payment model, though some skeptics question just how far away from fee-for-service that effort will actually go.
- "There's increasing talk about whether the current model is sustainable. Can our country really afford this, or do we fundamentally need to undergo some other form of major change?" Brennan said. "I hear more than whispers of some form of a single payer. I don't know if that's the answer, but it speaks to the difficulty of operating under conflicting incentive systems."
Read more from Bob’s interview.