Chapter 14 - Solution #10: Make Changes in Overall Healthcare System Processes

Summary

The prevailing business model in which most medical practices, hospitals, and larger healthcare networks operate is a volume-based, fee-for-service model. Income to the healthcare provider is based substantially on the number of patients seen. As a consequence, there is pressure on the healthcare provider to see as many patients as possible. It is well known that such an “assembly-line, piece-rate-pay” approach is a major factor in promoting burnout. One alternative is the concierge medical practice, and in the United States this alternative is growing modestly among primary care physicians, where it is most clearly applicable. A more widely applicable alternative is quality-based compensation, though actually determining the relevant metrics of quality and administering such a system have proven problematic. As yet there is no clear-cut alternative to the fee-for-service model, but there is widespread agreement that the unintended consequences of the model are increased risks of burnout. The spike in telemedicine brought on by the pandemic shows that when changes in healthcare are seen as imperative, systems-level strategies can indeed change, and quickly.