Shivan J. Mehta, MD, MBA and David A. Asch, MD, MBA
Outcome-based payment more closely aligns payments with what patients want, which is better health rather than more health care. But these approaches remain challenging to implement.
Measuring outcomes alone is not the answer. There should be a way to reward the doctor for educating a patient about lifestyle modifications and then documenting that the care provided followed patient preferences.
Acknowledging the roles and views of the caregiver may be the first step to resolving disagreements between caregivers and clinicians over artificial nutrition at the end of life.
AMA J Ethics. 2017;19(7):656-662. doi:
10.1001/journalofethics.2017.19.7.ecas3-1707.
The picture that emerges from study of physician economic behavior is mixed, but from the intensity of responses by some professional societies to Medicare's coding modifier proposal, it appears that economic incentives matter a lot to many of their members.
Treatment decisions in high-risk situations require a dynamic relationship between doctor and patient in which patient preferences and clinician recommendations contribute equally in shaping a final treatment decision.
In the same way that we learn about normal variations in blood pressure, we need to learn about “normal” variations in sexual interests and practices. We want to avoid clueless questions or unintentionally inflammatory statements.