AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. July 2013, Volume 15, Number 7: 561-631.

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July 2013 Contents

Incentives and Motivation in Medical Care

Ethics Poll

Which of the following models of payment do you think would be most effective in promoting quality and safety in patient care?
Pay physicians for each procedure or task they perform (including talking with and educating patients).
Align physician pay with outcomes--that's what patients care about most.
Pay physicians for complying with practice standards, regardless of outcome; physicians cannot be held responsible for whether or not patients improve.
None of the above.
Don't know.

What do you think should be done to reduce the gap in pay between generalist and specialist physicians?
Nothing. Specialists have more education, training, and expertise.
Hospitals and multispecialty practice groups should agree about the value of the services their physicians offer and pay physicians based on the agreed value of services in patient outcomes (e.g., helping patients maintain cardiac health may be as valuable as the surgery patients get if they do not maintain cardiac health).
Hospitals and multispecialty practice groups should pay physicians for the nonprocedural activities (e.g., care coordination, phone calls, patient counseling) that primary care physicians spend more time on than specialists.
Don't know.

In a practice model known as concierge (or retainer) practice, patients pay the physician an annual sum (a retainer) in addition to payment for services. The physicians have fewer patients than other practices do, and, in return for the retainer, patients receive such benefits as same-day appointments, house calls, longer office visits, and accompaniment on visits to specialists. Some say that physicians who have concierge practices are not fulfilling their professionís pledge to care for all members of society who need medical attention. Do you agree?
Yes.
No.
Don't know.

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From the Editor

Rewarding Ethical Medicine
Allison R. Bond
Full Text | PDF
Virtual Mentor. 2013; 15:563-564.

Educating for Professionalism

Ethics Cases

How Do We Reward the Kind of Care We Want?
Commentary by Shivan J. Mehta and David A. Asch
Full Text | PDF
Virtual Mentor. 2013; 15:565-569.

Pay for Performance: What We Measure Matters
Commentary by Laura A. Petersen
Full Text | PDF
Virtual Mentor. 2013; 15:570-575.

Ethical Concierge Medicine?
Commentary by William Martinez and Thomas H. Gallagher
Full Text | PDF
Virtual Mentor. 2013; 15:576-580.

The Code Says

AMA Code of Medical Ethics’ Opinions on Financial Incentives and Conflicts under Various Models of Payment for Care
Full Text | PDF
Virtual Mentor. 2013; 15:581-586.

Journal Discussion

Testing the Incentive Power of Pay for Performance
Ali Irshad, Matthew Janko, and Jacob M. Koshy
Full Text | PDF
Virtual Mentor. 2013; 15:587-591.

Supply-Sensitive Variations in Care
Anita Arora and Alicia L. True
Full Text | PDF
Virtual Mentor. 2013; 15:592-595.

State of the Art and Science

Coding Patient Information, Reimbursement for Care, and the ICD Transition
Christopher G. Chute
Full Text | PDF
Virtual Mentor. 2013; 15:596-599.

Geisinger: An Insider’s View
Greg F. Burke
Full Text | PDF
Virtual Mentor. 2013; 15:600-602.

Law, Policy, and Society

Health Law

State Implementation of the Affordable Care Act
Alexander H. Sommer
Full Text | PDF
Virtual Mentor. 2013; 15:603-605.

Policy Forum

Will the Medicare Value Modifier Get Us Closer to Rewarding Quality Care?
Allan H. Goroll
Full Text | PDF
Virtual Mentor. 2013; 15:606-610.

History, Art, and Narrative

Medical Narrative

A Story of Three Generations in Health Care
Daniel B. Shulkin, Mark W. Shulkin, and David J. Shulkin
Full Text | PDF
Virtual Mentor. 2013; 15:611-614.

Op-Ed and Correspondence

Op-Ed

Educational Debt and Specialty Choice
Albert L. Hsu and Kelly Caverzagie
Full Text | PDF
Virtual Mentor. 2013; 15:615-619.

Resources

Suggested Readings and Resources
PDF
Virtual Mentor. 2013; 15:620-628.

About the Contributors
Full Text | PDF
Virtual Mentor. 2013; 15:629-631.